Association between Socioeconomic Status and Longitudinal Sleep Quality Patterns Mediated by Depressive Symptoms.

STUDY OBJECTIVES We aimed to examine whether associations between socioeconomic status (SES) and longitudinal sleep quality patterns are mediated by depressive symptoms. METHODS We utilized data on 3,347 participants in the Korean Genome and Epidemiology Study aged 40-69 years at baseline from 2001-2002 who were followed up for 16 years. A group-based modeling approach was used to identify sleep quality trajectories using the Pittsburgh Sleep Quality Index (year 2, 6, 8, 10, and 12). Educational attainment (college graduated or less), monthly household income (≥$2,500 or less), and occupation (unemployed, manual labor, and professional labor) at baseline (year 0) were used for analyses. Depressive symptoms were assessed using Beck's Depression Inventory at year 4. Associations between SES and sleep quality patterns were examined using a multinomial logistic regression model. The mediation effect of depressive symptoms was further examined using PROC CAUSALMED. RESULTS We identified five distinct sleep quality trajectories: "normal-stable" (n=1,697), "moderate-stable" (n=1,157), "poor-stable" (n=320), "developing to poor" (n=84), and "severely poor-stable" (n=89). Overall, associations between SES levels and longitudinal sleep patterns were not apparent after full adjustment for socio-demographic and lifestyle factors measured at baseline. Depressive symptoms, however, tended to fully mediate associations between SES levels and sleep quality patterns (odds ratio range for indirect effects of depressive symptoms: for education, 1.05-1.17; for income, 1.05-1.15). CONCLUSION A significant mediating role for depressive symptoms between SES levels and longitudinal sleep quality warrants consideration among mental health care professionals.