Differential Co-Occurring Patterns Between Depressive Symptomatology and Sleep-Wake-Related Disturbances in Mood Disorders

Figures & data

Table 1 Sociodemographic Characteristics of Participants (n=657)

	Total	PSQ+HI*	PSQ+MI	PSQ+LI	p-value for χ^2/ANOVA
	n=657	n=150	n=248	n=259
Sex (n, %)
Female	439 (66.8)	119 (79.3)	149 (60.1)	175 (66.0)	<0.001
Male	218 (33.2)	31 (20.7)	99 (39.9)	90 (34.0)
Age (n, %)
≤30 years	92 (15.9)	22 (17.1)	33 (15.4)	37 (15.8)
31–44 years	181 (31.4)	49 (38.0)	71 (33.2)	61 (26.1)	0.13
≥ 45 years	304 (52.7)	58 (45.0)	110 (51.4)	136 (58.1)
Marital status (n, %)
Single	217 (37.6)	54 (41.9)	80 (37.4)	83 (35.5)	0.06
Married	251 (43.5)	43 (33.3)	94 (43.9)	114 (48.7)
Other	109 (18.9)	32 (24.8)	40 (18.7)	37 (15.8)
Birth place (n, %)
Urban	450 (79.8)	111 (86.7)	159 (75.7)	180 (79.6)	0.05
Rural	114 (20.2)	17 (13.3)	51 (24.3)	46 (20.4)
Education (n, %)
University and higher	271 (47.1)	48 (37.5)	112 (52.3)	111 (47.6)
Senior high school	205 (35.7)	53 (41.4)	72 (33.6)	80 (34.3)	0.10
Junior high school and lower	99 (17.2)	27 (21.1)	30 (14.0)	42 (18.0)
Work status (n, %)
Employed	221 (38.6)	46 (35.7)	83 (39.3)	92 (39.5)	0.74
Unemployed	352 (61.4)	83 (64.3)	128 (60.7)	141 (60.5)
Income (n, %)
High (≥40,000 NTD/month)	157 (28.6)	23 (19.0)	63 (30.7)	71 (31.8)
Moderate (10,000–39,999 NTD/month)	174 (31.7)	45 (37.2)	55 (26.8)	74 (33.2)	0.04
Low (0–9999 NTD/month)	218 (39.7)	53 (43.8)	87 (42.4)	78 (35.0)
Body mass index (n, %)
Healthy weight (18.5- <24.0 kg/m^2)	305 (54.0)	63 (50.0)	111 (53.1)	131 (57.0)
Underweight (<18.5 kg/m^2)	43 (7.6)	11 (8.7)	19 (9.1)	13 (5.7)	0.61
Overweight (24.0- <27.0 kg/m^2)	155 (27.4)	34 (27.0)	57 (27.3)	64 (27.8)
Obesity (≥27.0 kg/m^2)	62 (11.0)	18 (14.3)	22 (10.5)	22 (9.6)
Lifestyle (n, %)
Regular exercise (> 2 times/week)	312 (54.7)	52 (40.6)	115 (54.8)	145 (62.5)	<0.001
Cigarette use
Non-smoker	372 (65.7)	81 (64.8)	136 (64.2)	155 (67.7)
Ex-smoker	75 (13.3)	12 (9.6)	32 (15.1)	31 (13.5)	0.43
Current smoker	119 (21.0)	32 (25.6)	44 (20.8)	43 (18.8)
Regular alcohol drinking>1year	96 (17.1)	27 (21.8)	26 (11.4)	43 (20.5)	0.01
Comorbid disease (n, %)
Cardiovascular disease	132 (23.2)	23 (18.0)	51 (24.2)	58 (25.1)	0.28
Endocrinology and metabolism disease	164 (29.1)	45 (35.4)	51 (24.4)	68 (30.0)	0.10
Gastroenterology disease	260 (45.5)	78 (60.9)	97 (45.8)	85 (36.6)	<0.001
Urinary system disease	62 (10.9)	17 (13.3)	29 (13.8)	16 (6.9)	0.04
Infectious disease	9 (1.6)	1 (0.8)	5 (2.4)	3 (1.3)	0.47
Neuromuscular disease	201 (35.3)	62 (48.8)	78 (37.0)	61 (26.3)	<0.001
Autoimmune disease/asthma and allergy	166 (29.0)	39 (30.5)	63 (29.7)	64 (27.6)	0.81
Hematology disease	83 (14.5)	23 (18.0)	31 (14.7)	29 (12.5)	0.37
Psychiatric diagnosis (n, %)
Bipolar affective disorder	313 (47.6)	55 (36.7)	103 (41.5)	155 (59.8)	<0.001
Major depressive disorder	344 (52.4)	95 (63.3)	145 (58.5)	104 (40.2)
Use of psychotropic agents (n, %)
Antidepressants	358 (54.8)	107 (72.3)	145 (58.9)	106 (40.9)	<0.001
Mood stabilizers	239 (36.5)	39 (26.2)	78 (31.7)	122 (47.1)	<0.001
Antipsychotics	264 (40.4)	71 (47.7)	94 (38.2)	99 (38.2)	0.12
Hypnotics use	432 (75.7)	111 (88.1)	163 (76.5)	158 (68.1)	<0.001
Beck Depression Inventory-II [mean (SD)]	14.8 (11.8)	31.8 (5.1)	16.3 (6.1)	3.5 (2.9)	<0.001
Beck Anxiety Inventory [mean (SD)]	13.2 (12.2)	26.1 (11.4)	13.3 (12.2)	6.1 (7.4)	<0.001

Abbreviations: *PSQ, poor sleep quality; HI, high insomnia; MI, moderate insomnia; LI, low insomnia; SD, standard deviation.

Table 2 Model Fitting Results for 3- to 5-Class Solutions in the Latent Class Analysis (n=657)

	3 Classes	4 Classes	5 Classes
Akaike Information Criterion	20,533.92	20,178.22	20,025.83
Sample-Size Adjusted Bayesian Information Criterion	20,694.07	20,392.19	20,293.62
Entropy	0.93	0.91	0.91
Lo-Mendell-Rubin Adjusted Likelihood Ratio test	0.0046	0.0002	0.6234
Parametric Bootstrapped Likelihood Ratio test	<0.0001	<0.0001	<0.0001

Table 3 Univariate Analysis for Sleep-Wake-Related Disturbances in Subgroups (n=657)

	Total	PSQ+HI*	PSQ+MI	PSQ+LI	p-value for χ2/ANONA
	n=657	n=150	n=248	n=259
Pittsburgh Sleep Quality Index
Total scores ≥ 6 (n, %)	485 (84.9)	118 (93.7)	189 (88.7)	178 (76.7)	<0.001
Component scores ≥1 (n, %)
Subjective sleep quality	245 (42.9)	84 (66.7)	98 (46.0)	63 (27.2)	<0.001
Sleep latency	314 (55.0)	86 (68.3)	116 (54.5)	112 (48.3)	0.001
Sleep duration	119 (20.8)	40 (31.7)	40 (18.8)	39 (16.8)	0.003
Sleep efficiency	125 (21.9)	41 (32.5)	42 (19.7)	42 (18.1)	0.004
Sleep disturbance	448 (78.5)	105 (83.3)	173 (81.2)	170 (73.3)	0.04
Daytime dysfunction	162 (28.4)	63 (50.0)	61 (28.6)	38 (16.4)	<0.001
Eveningness chronotype (n, %)	126 (26.1)	45 (42.9)	55 (29.6)	26 (13.6)	<0.001
Night and daytime symptoms of insomnia
Subjective sleep loss ≥ 2 hours	177 (34.3)	49 (44.5)	70 (36.8)	58 (26.9)	0.004
Sleep initiation difficulty (n, %)	203 (35.9)	54 (43.5)	81 (38.6)	68 (29.3)	0.02
Sleep maintenance difficulty (n, %)	207 (36.6)	64 (51.6)	76 (36.2)	67 (28.9)	<0.001
Early morning awakening (n, %)	171 (30.3)	52 (41.9)	58 (25.1)	61 (29.0)	0.004
Daytime sleepiness (n, %)	231 (41.0)	63 (50.8)	76 (33.2)	92 (43.8)	0.003

Abbreviations: *PSQ, poor sleep quality; HI, high insomnia; MI, moderate insomnia; LI, low insomnia.

Figure 1 The co-occurring patterns between domains of depressive symptomatology with global scores and component scores in the Pittsburgh Sleep Quality Index (PSQI). C: cognitive domain; A: affective domain; S: somatic domain. The number (odds ratio) and thickness of the lines linking each domain and PSQI-related components reflect the effect sizes of associations. The co-occurring patterns are illustrated by participant groups. Panel (A): total participants. Panel (B): the poor sleep quality with high insomnia (PSQ+HI) group. Panel (C): the poor sleep quality with moderate insomnia (PSQ+MI) group. Panel (D): the poor sleep quality with low insomnia (PSQ+LI) group.

Figure 2 The co-occurring patterns between domains of depressive symptomatology with various nighttime and daytime symptoms of insomnia and chronotype preferences. C: cognitive domain; A: affective domain; S: somatic domain. The number (odds ratio) and thickness of the lines linking each domain and PSQI-related components reflect the effect sizes of associations. The co-occurring patterns are illustrated by participant groups. Panel (A): total participants. Panel (B): the poor sleep quality with high insomnia (PSQ+HI) group. Panel (C): the poor sleep quality with moderate insomnia (PSQ+MI) group. Panel (D): the poor sleep quality with low insomnia (PSQ+LI) group.