Asrullah Muhammad, Maula Ahmad Watsiq, Frans Sandra Olivia, Dewi Shita Listya, L'Hoir Monique, Feskens Edith J M, Melse-Boonstra Alida
Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands.
Faculty of Medicine, Public Health, and Nursing, Centre for Health Policy and Management, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Stress Health. 2025 Jun;41(3):e70046. doi: 10.1002/smi.70046.
Sleep quality and depression are known to be associated with anaemia in adults, but studies are limited among children and adolescents. The present study aimed to assess the association between sleep quality, depression, and haemoglobin concentration in Indonesian adolescents aged 10-19 years. Data of 452 adolescent boys and girls, aged 10-19 years old, were collected across all subdistricts in Gunungkidul district, Yogyakarta province, Indonesia, in 2021 (baseline) and 2022 (follow-up). Sleep quality and depression were assesed using The Pittsburgh Sleep Quality Index (PSQI) and The Kessler-10 Psychological Distress Scale (K10), respectively. Haemoglobin concentration was measured, with corrections applied for altitude and smoking. Anaemia status was defined as haemoglobin < 11.5 g/dL for adolescents aged 10-11 years old, < 12 g/dL for those aged 12-14 years old and for girls aged 15 years and older, and < 13 g/dL for boys aged 15 years old and older. Latent Class Analysis (LCA) was employed to identify distinct subgroups of adolescents based on shared patterns of sleep quality and depression. Multiple linear regression was applied to identify associations between class membership and haemoglobin concentration at baseline and follow-up, with adjustments for baseline haemoglobin concentration, sex, age, pubertal status, alcohol consumption, smoking status, and household income. The overall prevalence of anaemia was 21% at baseline and 29% at follow-up, with girls being more affected than boys. LCA yielded 5 classes of sleep quality and depression. We did not find an association between class membership and haemoglobin concentration at baseline. However, in comparison to class A and after adjustments, membership of class B (moderate-to-good sleep quality and low risk of depression, with some tiredness) predicted a reduction of 0.43 g/dL (95% CI: -0.79; -0.07), whereas membership of class C (moderate sleep quality and moderate risk of depression) predicted a reduction of 0.49 g/dL (95% CI: -0.94; -0.04) in haemoglobin concentration at 1 year follow-up. Our study found that poor sleep quality and depression symptoms are associated with lower haemoglobin concentrations over time. Mental health and sleep quality should therefore be considered in intervention programs that address anaemia.
已知睡眠质量和抑郁与成年人贫血有关，但儿童和青少年中的相关研究有限。本研究旨在评估印度尼西亚10至19岁青少年的睡眠质量、抑郁与血红蛋白浓度之间的关联。2021年（基线）和2022年（随访）在印度尼西亚日惹省Gunungkidul区的所有分区收集了452名10至19岁青少年男孩和女孩的数据。分别使用匹兹堡睡眠质量指数（PSQI）和凯斯勒10项心理困扰量表（K10）评估睡眠质量和抑郁。测量血红蛋白浓度，并对海拔和吸烟情况进行校正。贫血状态定义为：10至11岁青少年血红蛋白<11.5 g/dL，12至14岁青少年以及15岁及以上女孩血红蛋白<12 g/dL，15岁及以上男孩血红蛋白<13 g/dL。采用潜在类别分析（LCA）根据睡眠质量和抑郁的共同模式识别青少年的不同亚组。应用多元线性回归确定基线和随访时类别归属与血红蛋白浓度之间的关联，并对基线血红蛋白浓度、性别、年龄、青春期状态、饮酒、吸烟状况和家庭收入进行调整。贫血的总体患病率在基线时为21%，随访时为29%，女孩比男孩受影响更大。LCA产生了5种睡眠质量和抑郁类别。我们在基线时未发现类别归属与血红蛋白浓度之间存在关联。然而，与A类相比并经过调整后，B类（睡眠质量中等至良好且抑郁风险较低，但有一些疲劳）的类别归属预测血红蛋白浓度在1年随访时降低0.43 g/dL（95%CI：-0.79；-0.07），而C类（睡眠质量中等且抑郁风险中等）的类别归属预测血红蛋白浓度降低0.49 g/dL（95%CI：-0.94；-0.04）。我们的研究发现，随着时间的推移，睡眠质量差和抑郁症状与较低的血红蛋白浓度有关。因此，在解决贫血问题的干预项目中应考虑心理健康和睡眠质量。
