Association of weekend catch-up sleep ratio with depressive risk: insights from NHANES 2021-2023

Abstract

Background: Depression is a common global mental health issue, affecting around 3.8% of the population. It significantly impacts quality of life and social functioning, posing a major public health challenge. Sleep is a key factor influencing depression, with both sleep quality and quantity linked to mental health. However, sleep deprivation is widespread, and many people compensate by "weekend sleep recovery." The effects of sleep deprivation and weekend recovery on depression risk are unclear, as irregular sleep patterns may worsen depressive symptoms. This study introduces the "Weekend Catch-up Sleep Ratio" (CUS ratio) to better understand the relationship between sleep patterns and depression.

Methods: Cross-sectional data were obtained from individuals who participated in the 2021-2023 National Health and Nutrition Examination Survey (NHANES) and had complete data on CUS and the Patient Health Questionnaire (PHQ-9). Multivariable logistic regression was performed to assess the potential independent association between depression and the CUS ratio. Additionally, smoothing curve fitting, threshold effect analysis, subgroup analysis, and interaction tests were conducted.

Results: A total of 4,656 individuals were analyzed, categorized by depression symptoms (PHQ-9 score of 10 or higher), with an overall depression risk of 12.4%. In the adjusted model, the CUS ratio was significantly positively associated with depression risk (AOR = 1.75, 95% CI: 1.25-2.45), exhibiting a nonlinear threshold effect (inflection point at 1.11). When the CUS ratio ≤ 1.11, an increase in the ratio was associated with a reduced depression risk (AOR = 0.34, 95% CI: 0.13-0.89), whereas when the CUS ratio > 1.11, each unit increase in the ratio significantly increased depression risk by 187% (AOR = 2.87, 95% CI: 1.84-4.50). Individuals with education levels of less than 9th grade, some college or an Associate of Arts (AA) degree, those who are overweight (25 ≤ BMI < 30), and those without diabetes appeared more sensitive to fluctuations in sleep patterns. In the adjusted model for the severity of depressive symptoms, the CUS ratio was significantly positively associated with depression severity (Aβ = 0.19, 95% CI: 0.09-0.28), also exhibiting a nonlinear threshold effect (inflection point at 1.11). When the CUS ratio ≤ 1.11, an increase in the ratio was associated with a reduction in depression severity (Aβ = -0.35, 95% CI: -0.62 to -0.09), whereas when the CUS ratio > 1.11, each unit increase in the ratio significantly increased depression severity (Aβ = 0.36, 95% CI: 0.24-0.49). In particular, individuals without diabetes appeared more sensitive to fluctuations in sleep patterns.

Conclusions: This study suggests that maintaining a balanced sleep pattern, with a CUS ratio between 1 and 1.11, may help reduce depression risk and promote better mental health.

Keywords: Depressive; NHANES; Sleep pattern fluctuations; Weekend catch-up sleep ratio.

Fig. 1

Flow chart of study participants

Fig. 2

The smoothing curve fitting results of CUS ratio and Depression. a A non-linear relationship between the CUS ratio and depression symptoms (PHQ-9 score of 10 or higher) was identified using the generalized additive model. b A non-linear relationship between the CUS ratio and the severity of depressive symptoms (no depressive symptoms, mild depression, moderate depression, moderate-to-severe depression, and severe depression) was also identified. CUS ratio = average weekend sleep duration/average weekday sleep duration. The solid red line represents the smoothed curve fit, while the blue dotted lines indicate the 95% confidence interval

Fig. 3

Stratified analyses for the association between CUS ratio and depression. All models were adjusted for 10 risk factors, excluding stratification variables, and the interaction significance was assessed using the likelihood ratio test