Stress Research Institute, Stockholm University, Stockholm, Sweden.
Indian Statistical Institute, North-East Centre, Tezpur, India.
J Sleep Res. 2017 Jun;26(3):266-276. doi: 10.1111/jsr.12494. Epub 2017 Jan 24.
Job strain and low social support at work are recognized risk factors for depression. However, people with poor sleep may represent a high-risk group more likely to benefit from interventions against work stress. The present study examined whether the associations between these work stressors and depressive symptoms differed by strata of sleep disturbances (effect modification/effect moderation) considering repeat measures of work characteristics and sleep. The study was based on five biennial measurements of the Swedish Longitudinal Occupational Survey of Health, including 1537 respondents recurrently in paid work, from an originally representative sample of the Swedish working population. High work demands, low decision authority and low social support were measured waves 2 and 4, sleep disturbances (putative moderator/modifier) waves 1 and 3, and depressive symptoms (outcome) wave 5. Causal effect modification, whether the effect of working conditions differed by strata of sleep disturbances, was analysed by structural nested mean modelling estimated using a regression-with-residuals with inverse-probability-of-treatment weighting approach. High demands and low social support, but not low decision authority, influenced subsequent depressive symptoms. The relationship between social support and depressive symptoms was not apparently modified by sleep disturbances. However, disturbed sleep wave 3 modified the effect of high demands wave 4 (coefficient 1.77, P < 0.05) on depressive symptoms wave 5. The results indicate that high job demands is a stronger risk factor for depressive symptoms in people with pre-existing sleep disturbances, suggesting that targeted workplace interventions may be more effective when it comes to preventing negative effects of job demands.
工作压力和工作中的低社会支持被认为是抑郁的风险因素。然而，睡眠质量差的人可能代表着一个高风险群体，他们更有可能从针对工作压力的干预措施中受益。本研究考察了在考虑到工作特征和睡眠的重复测量的情况下，这些工作压力源与抑郁症状之间的关联是否因睡眠障碍的分层（效应修饰/效应调节）而有所不同。该研究基于瑞典健康职业纵向研究的五次两年期测量，包括来自瑞典工作人口原始代表性样本中反复有偿工作的 1537 名受访者。高工作需求、低决策自主权和低社会支持在第 2 波和第 4 波中进行测量，睡眠障碍（假定的调节因素/修饰因素）在第 1 波和第 3 波中进行测量，抑郁症状（结果）在第 5 波中进行测量。通过结构嵌套均值模型分析因果效应修饰，即工作条件的效果是否因睡眠障碍的分层而不同，使用具有逆处理概率加权的回归残差的回归进行估计。高需求和低社会支持，但不是低决策自主权，影响随后的抑郁症状。社会支持与抑郁症状之间的关系似乎不受睡眠障碍的影响。然而，第 3 波的睡眠障碍修饰了第 4 波高需求（系数 1.77，P<0.05）对第 5 波抑郁症状的影响。结果表明，高工作需求是存在睡眠障碍的人患抑郁症状的更强风险因素，这表明针对工作场所的干预措施可能更有效，可以预防工作需求的负面影响。
