Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
JAMA Netw Open. 2023 Aug 1;6(8):e2328798. doi: 10.1001/jamanetworkopen.2023.28798.
Shift work may lead to adverse health outcomes. Whether shift work is associated with depression and anxiety, and to what extent lifestyle mediates the associations, remains unknown.
To explore the associations of shift work, its type, frequency, and working years with anxiety and depression and to examine the potential mediating role of lifestyles.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included 175 543 employed or self-employed workers who participated in the UK Biobank baseline survey (2006-2010). Data analysis was conducted from November 2022 to January 2023.
Employment and shift work status information was obtained from baseline. Lifestyles included smoking, physical activity, alcohol consumption, dietary characteristics, sleep duration, sedentary time, and body mass index (BMI).
Depression and anxiety were identified based on electronic health records. Cox proportional hazard regression models were used to calculate the association of shift work with anxiety and depression, and cause mediation analyses we used to test the mediating role of lifestyle factors in this association.
Of the 175 543 included participants (mean [SD] age, 52.6 [7.1] years; 88 290 men [50.3%]; 167 495 White participants [95.4%]), 27 637 participants (16.2%) reported shift work. During a median (IQR) follow-up of 9.06 (8.35-9.75) years, 3956 workers (2.3%) developed depression and 2838 (1.7%) developed anxiety. In the fully adjusted model, individuals who reported engaging in shift work, or shift workers, had a higher risk of depression (HR, 1.22; 95% CI, 1.12-1.33; P < .001) and anxiety (HR, 1.16; 95% CI, 1.04-1.28; P < .001), and the risk was positively associated with shift frequency. Among shift workers, there was no significant difference between night shifts and nonnight shifts. In the dose-association analyses, years of shift work were negatively associated with the risk of depression and anxiety. Smoking, sedentary time, BMI, and sleep duration were identified as the main potentially modifiable mediators. These mediators together explained 31.3% of the association between shift work and depression and 21.2% of the association between shift work and anxiety.
In this cohort study, shift work was significantly associated with a higher risk of depression and anxiety, and lifestyle factors partially mediated the associations. These findings not only support that shift work should be considered an occupational hazard, but also provide evidence for the urgent need for the development of public health interventions that promote healthy lifestyles aimed at improving the mental health of shift workers.
轮班工作可能导致不良健康后果。轮班工作是否与抑郁和焦虑有关，以及生活方式在多大程度上调节这种关联，目前尚不清楚。
探讨轮班工作、轮班类型、轮班频率和工作年限与焦虑和抑郁的关联，并检验生活方式的潜在中介作用。
设计、地点和参与者：本队列研究纳入了参加英国生物银行基线调查（2006-2010 年）的 175543 名在职或自雇工人。数据分析于 2022 年 11 月至 2023 年 1 月进行。
从基线获得就业和轮班工作状况信息。生活方式包括吸烟、体力活动、饮酒、饮食特征、睡眠持续时间、久坐时间和体重指数（BMI）。
根据电子健康记录确定抑郁和焦虑。使用 Cox 比例风险回归模型计算轮班工作与抑郁和焦虑的关联，并使用因果中介分析检验生活方式因素在这种关联中的中介作用。
在纳入的 175543 名参与者中（平均[标准差]年龄 52.6[7.1]岁；88290 名男性[50.3%]；167495 名白种人参与者[95.4%]），27637 名（16.2%）报告从事轮班工作。在中位（IQR）随访 9.06（8.35-9.75）年期间，3956 名工人（2.3%）出现抑郁，2838 名（1.7%）出现焦虑。在完全调整模型中，报告从事轮班工作或轮班工人的个体患抑郁的风险更高（HR，1.22；95%CI，1.12-1.33；P<0.001）和焦虑（HR，1.16；95%CI，1.04-1.28；P<0.001），且风险与轮班频率呈正相关。在轮班工人中，夜班和非夜班之间没有显著差异。在剂量关联分析中，轮班工作年限与抑郁和焦虑风险呈负相关。吸烟、久坐时间、BMI 和睡眠持续时间被确定为主要潜在可调节的中介因素。这些中介因素共同解释了轮班工作与抑郁之间关联的 31.3%和轮班工作与焦虑之间关联的 21.2%。
在这项队列研究中，轮班工作与抑郁和焦虑风险增加显著相关，生活方式因素部分调节了这种关联。这些发现不仅支持轮班工作应被视为职业危害，还为迫切需要制定促进健康生活方式的公共卫生干预措施提供了证据，以改善轮班工人的心理健康。
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