title: Residual Effects of Restless Sleep over Depressive Symptoms on Chronic Medical Conditions: Race by Gender Differences.
abstract: Sleep and depression are comorbid problems that contribute to the development of chronic medical conditions (CMC) over time. Although racial and gender differences in the bidirectional associations between sleep, depression, and CMC are known, very limited information exists on heterogeneity of the residual effects of sleep problems over depressive symptoms on CMC across race by gender groups.
  
  
  
  Using a life-course perspective, the present study compared race by gender groups for residual effects of restless sleep over depressive symptoms on CMC.
  
  
  
  We used data from waves 1 (year 1986), 4 (year 2001), and 5 (year 2011) of the Americans' Changing Lives Study (ACL). The study followed 294 White men, 108 Black men, 490 White women, and 237 Black women for 25 years. Restless sleep, depressive symptoms (Center for Epidemiological Studies-Depression scale [CES-D]), and number of chronic medical conditions (hypertension, diabetes, chronic lung disease, heart disease, stroke, cancer, and arthritis) were measured in 1986, 2001, and 2011. We employed multi-group cross-lagged modeling, with chronic medical conditions as the outcome and race by gender as the groups.
  
  
  
  Major group differences were found in the residual effect of restless sleep on CMC over depressive symptoms across race by gender groups. Restless sleep in 2001 predicted CMC 10 years later in 2011 among Black women (standardized adjusted B = .135, P < .05) and White men (standardized adjusted = .145, P < .01) and White women (standardized adjusted B = .171, P < .001) but not Black men (standardized adjusted B = .001, P > .05).
  
  
  
  Race by gender heterogeneity in the residual effect of restless sleep over depressive symptoms on CMC over 25 years suggests that comorbid poor sleep and depressive symptoms differently contribute to development of multi-morbidity among subpopulations based on the intersection of race and gender. Thus, interventions that try to prevent comorbid sleep problems and depression as a strategy to prevent medical conditions may benefit from tailoring based on the intersection of race and gender.
authors.affiliation: Department of Psychiatry, University of Michigan, 4250 Plymouth Road, SPC 5763, Ann Arbor, MI, 48109-2700, USA. assari@umich.edu.|Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI, USA. assari@umich.edu.
authors.forename: Shervin
authors.initials: S
authors.lastname: Assari
authors.affiliation: Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Sonnega
authors.affiliation: Dartmouth Centers for Health and Aging, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA.
authors.forename: Renee
authors.initials: R
authors.lastname: Pepin
authors.affiliation: Department of Psychiatry, University of Michigan, 4250 Plymouth Road, SPC 5763, Ann Arbor, MI, 48109-2700, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Leggett
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D000368:Aged; D002908:Chronic Disease / Q000208:ethnology*; D003863:Depression / Q000208:ethnology*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D012893:Sleep Wake Disorders / Q000208:ethnology*; D014481:United States / Q000453:epidemiology; D044465:White People / Q000523:psychology* / Q000706:statistics & numerical data
keywords: Additive effect; Chronic medical conditions; Depressive symptoms; Ethnic groups; Intersectionality; Residual effects; Sleep quality
references.citation: J Psychiatr Res. 2010 Nov;44(15):1043-51
references.pmid: 20537350
references.citation: JAMA Neurol. 2014 Oct;71(10):1218-27
references.pmid: 25090106
references.citation: Gen Hosp Psychiatry. 2014 Jul-Aug;36(4):431-6
references.pmid: 24793895
references.citation: Sleep. 1999 May 1;22 Suppl 2:S366-72
references.pmid: 10394609
references.citation: Neurotoxicology. 2010 Jan;31(1):126-33
references.pmid: 19853625
references.citation: Sleep Med. 2005 Jan;6(1):55-61
references.pmid: 15680297
references.citation: Am J Public Health. 2007 Jan;97(1):76-83
references.pmid: 17138911
references.citation: NCHS Data Brief. 2013 Aug;(127):1-8
references.pmid: 24152538
references.citation: GMS Curr Top Otorhinolaryngol Head Neck Surg. 2008;7:Doc03
references.pmid: 22073090
references.citation: World J Biol Psychiatry. 2009;10(4):269-75
references.pmid: 19921968
references.citation: Med Care. 2013 Jun;51(6):540-7
references.pmid: 23552429
references.citation: BMC Public Health. 2014 Sep 12;14:946
references.pmid: 25213995
references.citation: J Gerontol B Psychol Sci Soc Sci. 2016 Jan;71(1):118-28
references.pmid: 26329114
references.citation: Brain Behav Immun. 2013 Jul;31:143-52
references.pmid: 23201587
references.citation: J Racial Ethn Health Disparities. 2015 Dec;2(4):481-93
references.pmid: 26863554
references.citation: Int J Equity Health. 2012 Feb 16;11:8
references.pmid: 22336144
references.citation: Am J Mens Health. 2013 Jul;7(4 Suppl):19S-30S
references.pmid: 23462019
references.citation: Milbank Q. 1990;68(3):383-411
references.pmid: 2266924
references.citation: Eur Respir J. 2002 Jan;19(1):121-6
references.pmid: 11843310
references.citation: Int Cardiovasc Res J. 2014 Apr;8(2):44-51
references.pmid: 24936480
references.citation: Front Cell Neurosci. 2015 Jul 10;9:268
references.pmid: 26217190
references.citation: Int J Prev Med. 2014 Apr;5(4):405-13
references.pmid: 24829727
references.citation: Mol Neurobiol. 2016 Oct;53(8):5191-202
references.pmid: 26399644
references.citation: J Psychosom Res. 2004 May;56(5):497-502
references.pmid: 15172205
references.citation: J Gerontol A Biol Sci Med Sci. 1995 Sep;50(5):M280-4
references.pmid: 7671031
references.citation: J Health Soc Behav. 1994 Sep;35(3):213-34
references.pmid: 7983335
references.citation: Psychol Rep. 2008 Jun;102(3):873-83
references.pmid: 18763459
references.citation: Psychol Bull. 2014 May;140(3):774-815
references.pmid: 24417575
references.citation: Health Psychol. 2011 Jul;30(4):453-62
references.pmid: 21480713
references.citation: J Racial Ethn Health Disparities. 2016 Sep;3(3):423-30
references.pmid: 27294736
references.citation: J Pers. 2009 Dec;77(6):1677-706
references.pmid: 19796064
references.citation: Cochrane Database Syst Rev. 2002;(2):CD003161
references.pmid: 12076472
references.citation: J Clin Hypertens (Greenwich). 2013 Aug;15(8):593-9
references.pmid: 23889723
references.citation: Res Soc Work Pract. 2011 May;21(3):269-277
references.pmid: 24436576
references.citation: Psychol Med. 2009 Apr;39(4):591-601
references.pmid: 18588740
references.citation: J Am Geriatr Soc. 1997 Jan;45(1):1-7
references.pmid: 8994480
references.citation: Aging Ment Health. 2015 Jul;19(7):584-94
references.pmid: 25033373
references.citation: Immunology. 2015 Jan 10;144(3):365-373
references.pmid: 25580634
references.citation: Sleep Med Rev. 2004 Apr;8(2):119-32
references.pmid: 15033151
references.citation: Curr Psychiatry Rep. 2011 Dec;13(6):467-75
references.pmid: 21927805
references.citation: J Health Soc Behav. 2009 Dec;50(4):476-92
references.pmid: 20099452
references.citation: J Gen Intern Med. 2007 Sep;22(9):1292-7
references.pmid: 17610120
references.citation: J Obes. 2012;2012:601872
references.pmid: 22666556
references.citation: Sleep Med. 2012 Sep;13(8):1039-49
references.pmid: 22841028
references.citation: Pharmacol Rep. 2014 Oct;66(5):776-81
references.pmid: 25149980
references.citation: Soc Ment Health. 2013 Jul 1;3(2):
references.pmid: 24224131
references.citation: Int J Prev Med. 2013 Nov;4(11):1251-7
references.pmid: 24404358
references.citation: J Natl Med Assoc. 2011 Jul;103(7):576-84
references.pmid: 21999032
references.citation: Arch Gen Psychiatry. 2007 Mar;64(3):305-15
references.pmid: 17339519
references.citation: Cleve Clin J Med. 2011 Aug;78(8):549-58
references.pmid: 21807927
references.citation: Neuropsychology. 2014 Jul;28(4):506-18
references.pmid: 24773417
references.citation: J Clin Sleep Med. 2006 Oct 15;2(4):403-6
references.pmid: 17557467
references.citation: BMJ. 1997 Feb 22;314(7080):547-52
references.pmid: 9055712
references.citation: Am J Epidemiol. 2010 Dec 1;172(11):1238-49
references.pmid: 20884682
references.citation: Diabetes Care. 2013 Nov;36(11):3557-65
references.pmid: 24026552
references.citation: BMC Med. 2013 Sep 12;11:200
references.pmid: 24228900
references.citation: J Racial Ethn Health Disparities. 2015 Sep;2(3):385-94
references.pmid: 26863467
references.citation: JAMA. 2006 Nov 1;296(17):2112-23
references.pmid: 17077376
references.citation: Sleep Disord. 2014;2014:374732
references.pmid: 24808961
references.citation: Sleep Med Rev. 2010 Feb;14(1):35-46
references.pmid: 19939713
references.citation: Am J Mens Health. 2013 Jul;7(4 Suppl):58S-67S
references.pmid: 23609347
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2013 Dec;48(12):1941-9
references.pmid: 23732705
references.citation: Sleep. 2007 Feb;30(2):213-8
references.pmid: 17326547
references.citation: Int J Travel Med Glob Health. 2014 Summer;2(3):107-113
references.pmid: 31396543
references.citation: J Occup Environ Med. 2013 Sep;55(9):1007-14
references.pmid: 24013657
references.citation: J Health Soc Behav. 2004 Mar;45(1):99-113
references.pmid: 15179910
references.citation: J Natl Med Assoc. 2008 Mar;100(3):317-22
references.pmid: 18390025
references.citation: J Psychosom Res. 1993;37(2):163-70
references.pmid: 8463992
references.citation: Iran J Psychiatry Behav Sci. 2016 May 16;10(2):e3458
references.pmid: 27822270
references.citation: BMC Public Health. 2015 Sep 25;15:966
references.pmid: 26407623
references.citation: PLoS One. 2012;7(7):e40793
references.pmid: 22829885
references.citation: Gen Hosp Psychiatry. 2008 Sep-Oct;30(5):407-13
references.pmid: 18774423
references.citation: Int J Prev Med. 2014 Mar;5(3):269-79
references.pmid: 24829710
references.citation: Proc Nutr Soc. 1998 Feb;57(1):129-35
references.pmid: 9571718
references.citation: Curr Opin Psychiatry. 2011 Nov;24(6):519-25
references.pmid: 21897249
references.citation: Chest. 2009 Feb;135(2):563-572
references.pmid: 19201722
references.citation: Int Psychogeriatr. 2013 May;25(5):833-41
references.pmid: 23290766
references.citation: Am J Psychiatry. 1994 Aug;151(8):1172-80
references.pmid: 8037252
references.citation: Soc Sci Med. 2010 Sep;71(5):1027-36
references.pmid: 20621406
references.citation: J Consult Clin Psychol. 1995 Feb;63(1):79-89
references.pmid: 7896994
references.citation: CNS Spectr. 2016 Apr;21(2):184-98
references.pmid: 26307347
references.citation: J Am Board Fam Med. 2011 Mar-Apr;24(2):161-8
references.pmid: 21383215
references.citation: Am J Prev Med. 1994 Mar-Apr;10(2):77-84
references.pmid: 8037935
references.citation: Annu Rev Public Health. 2015 Mar 18;36:417-40
references.pmid: 25785893
references.citation: Am J Public Health. 2010 May;100(5):933-9
references.pmid: 19846689
references.citation: J Racial Ethn Health Disparities. 2015 Dec;2(4):589-97
references.pmid: 26863563
references.citation: Curr Opin Psychiatry. 2009 Jan;22(1):32-6
references.pmid: 19122532
references.citation: Sleep. 1998;21(1):27-36
references.pmid: 9485530
references.citation: J Epidemiol Community Health. 2014 Oct;68(10):971-8
references.pmid: 24970764
references.citation: Front Psychol. 2014 Apr 23;5:304
references.pmid: 24795668
references.citation: Rehabil Psychol. 2014 May;59(2):220-229
references.pmid: 24661030