Mapping association between sleep quality, chronotype and depressive symptoms in Chinese adults: A network analysis

BACKGROUND: The nocturnal chronotypes may be associated with an increased susceptibility to depression. Furthermore, the chronotype shows long-term stability and is not easily changed. Considering that sleep quality is related to chronotype and depressive symptoms, assessing the role of sleep quality in the relationship between chronotype and depressive symptoms could help to identify intervention targets. This study analyzed the network structure of sleep quality, chronotype, and depressive symptoms. METHODS: Data were obtained from the Psychology and Behavior Investigation of Chinese Residents (PBICR), a national, multi-cohort, comprehensive cross-sectional survey conducted in China. We used data from 2023 and included 28,312 individuals in our analysis. Identified central symptoms by expected influence value and bridge symptoms by bridge expected influence value. RESULTS: Among all the samples, 5327 (18.82%) reported experiencing depressive symptoms (PHQ-9 total scores≥10), and 7183 (25.37%) reported poor sleep quality (B-PSQI total scores >5). Network analysis demonstrated that "Sleep problem" had the highest expected influence centrality, followed by "Moving change", "Difficulty with concentrating", "Hopelessness" and "Sleep disturbance". Four bridge symptoms were identified: "Sleep problem", "Sleep disturbance", "Sleep efficiency", and "Suicidality". CONCLUSIONS: This exploratory study explored the inter-relationships between sleep quality, chronotype and depressive symptoms in Chinese adults. As central and bridge symptoms, sleep problems and sleep disturbance may represent potential intervention targets for addressing the depressive symptoms associated with chronotype.