Cheng Huiyu, Hu Wanting, Luo Shengyu, Feng Xiangyu, Chen Zijie, Yu Xiangyue, Li Huijun, Feng Xiuqiong, Chen Weiqing, Guo Vivian Yawei
Department of Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China.
Guangzhou Huangpu District Center for Disease Control and Prevention, Guangzhou, Guangdong, China.
J Affect Disord. 2025 Feb 1;370:235-240. doi: 10.1016/j.jad.2024.11.006. Epub 2024 Nov 4.
Despite growing evidence linking loneliness and depressive symptoms, the underlying pathways remain unclear. This study aims to assess the impact of loneliness on depressive symptoms among Chinese adolescents and investigate the potential mediating role of sleep disturbance.
A cross-sectional study was conducted between November and December 2021. Loneliness, depressive symptoms, and sleep disturbance were assessed using the UCLA Loneliness Scale, the 9-item Patient Health Questionnaire, and the Pittsburgh Sleep Quality Index questionnaire, respectively. Baron and Kenny's causal steps method and the Karlson-Holm-Breen method were applied to explore the mediating role of sleep disturbance. Subgroup analysis by gender was also conducted.
A total of 6838 adolescents were included, with 52.2 % boys and a mean age of 14.5 (SD = 1.6) years. Approximately 15.8 % of the adolescents reported depressive symptoms. Loneliness was positively associated with depressive symptoms after controlling for covariates (OR = 1.34, 95%CI = 1.31-1.36). After incorporating sleep disturbance into the model, the association was still significant (OR = 1.28, 95%CI = 1.25-1.31). Sleep disturbance partially mediated this association, contributing to 18.89 % of the total effects. The associations and mediation effects were consistent across both genders, with no moderating effect of gender observed.
The cross-sectional design limits the ability to establish causality.
Loneliness was significantly associated with depressive symptoms in Chinese adolescents and this association was partially mediated by sleep disturbance. Interventions aimed at reducing loneliness and improving sleep quality may help lower the risk of depressive symptoms in Chinese adolescents, regardless of genders. Nevertheless, further randomized controlled trials are needed to confirm these findings.
尽管越来越多的证据表明孤独与抑郁症状之间存在联系，但其潜在机制仍不清楚。本研究旨在评估孤独对中国青少年抑郁症状的影响，并探讨睡眠障碍的潜在中介作用。
于2021年11月至12月进行了一项横断面研究。分别使用加州大学洛杉矶分校孤独量表、9项患者健康问卷和匹兹堡睡眠质量指数问卷评估孤独感、抑郁症状和睡眠障碍。采用Baron和Kenny的因果步骤法以及Karlson-Holm-Breen法来探讨睡眠障碍的中介作用。还进行了按性别分组的亚组分析。
共纳入6838名青少年，其中52.2%为男孩，平均年龄为14.5（标准差=1.6）岁。约15.8%的青少年报告有抑郁症状。在控制协变量后，孤独感与抑郁症状呈正相关（比值比=1.34，95%置信区间=1.31-1.36）。将睡眠障碍纳入模型后，该关联仍然显著（比值比=1.28，95%置信区间=1.25-1.31）。睡眠障碍部分介导了这种关联，占总效应的18.89%。男女之间的关联和中介效应一致，未观察到性别的调节作用。
横断面设计限制了建立因果关系以及因果关系的能力。
孤独感与中国青少年的抑郁症状显著相关，且这种关联部分由睡眠障碍介导。旨在减少孤独感和改善睡眠质量的干预措施可能有助于降低中国青少年出现抑郁症状的风险，无论性别如何。然而，需要进一步的随机对照试验来证实这些发现。
