title: Associations of self-reported and objectively measured sleep disturbances with depression among primary caregivers of children with disabilities.
abstract: OBJECTIVE
  The objective of this study was to determine the association between sleep and depression using both self-reported (subjective) and actigraphic (objective) sleep traits.
  
  
  METHODS
  A cross-sectional study was conducted among 175 female primary caregivers of children with disabilities receiving care at a rehabilitation center in Punta Arenas, Chile. The eight-item Patient Health Questionnaire was used to ascertain participants' depression status. The Pittsburgh Sleep Quality Index was used to define subjective, or perceived, sleep quality. Wrist-worn actigraph monitors, worn for seven consecutive nights, were used to characterize objective sleep quality and disturbances. Interviewer-administered questionnaires were used to collect information on sociodemographic and lifestyle factors. Linear regression models were fit using continuous sleep parameters as the dependent variables and depression status as the independent variable. Multivariable models were adjusted for body mass index, marital status, smoking status, education level, and children's disabilities.
  
  
  RESULTS
  Using an eight-item Patient Health Questionnaire score ≥10, 26.3% of participants presented with depression. Depressed women were more likely to self-report overall poorer (subjective) sleep compared to non-depressed women; however, differences in sleep were not consistently noted using actigraphic (objective) sleep traits. Among the depressed, both sleep duration and total time in bed were significantly underestimated. In multivariable models, depression was negatively associated with sleep duration using both subjective (β=-0.71, standard error [SE] =0.25; P=0.006) and objective sleep (β=-0.42, SE =0.19; P=0.026).
  
  
  CONCLUSIONS
  The association between sleep and depression differed comparing subjective and objective methods of assessment. Research strategies allowing for the integration of both perceived and objective measures of sleep traits are encouraged.
authors.affiliation: Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
authors.forename: Olivia R
authors.initials: OR
authors.lastname: Orta
authors.affiliation: Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
authors.forename: Clarita
authors.initials: C
authors.lastname: Barbosa
authors.affiliation: Worker's Hospital, The Chilean Safety Association, Santiago, Chile.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Velez
authors.affiliation: Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
authors.forename: Bizu
authors.initials: B
authors.lastname: Gelaye
authors.affiliation: Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Chen
authors.affiliation: School of Sport and Exercise, Massey University, Wellington, New Zealand.
authors.forename: Lee
authors.initials: L
authors.lastname: Stoner
authors.affiliation: Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Williams
keywords: Chile; Pittsburgh Sleep Quality Index; actigraphy; caregiver; depression; sleep