Associations of cardiometabolic multimorbidity and sleep duration with depressive symptom onset and reversion: two longitudinal cohort studies.

BACKGROUND: The long-term associations between cardiometabolic multimorbidity (CMM) and depressive symptoms (DS) onset and symptom-state reversion, as well as the potential role of sleep duration in these associations, remain unclear. METHODS: We analyzed 14,468 participants from the China Health and Retirement Longitudinal Study (CHARLS) and 8551 from the English Longitudinal Study of Ageing (ELSA). DS was assessed using the CES-D scale; reversion was defined as a transition from DS to non-DS based on CES-D thresholds. Multi-state Markov models estimated transitions among non-DS, DS, and death according to baseline CMM and sleep duration (poor sleep duration defined as <6 or ≥9 h). Cox models evaluated associations with DS onset and reversion. RESULTS: In 14,468 Chinese participants (age 59.3 ± 9.5 years; 52.3% female), compared with those without CMDs, participants with one CMD or CMM had 13% and 29% higher hazards of transitioning from non-DS to DS (HR = 1.13 [1.05-1.22]; HR = 1.29 [1.09-1.54]) and 10% and 21% lower hazards of transitioning from DS to non-DS (HR = 0.90 [0.84-0.97]; HR = 0.79 [0.67-0.94]). In 8551 UK participants (age 66.1 ± 9.4 years; 56.2% female), the corresponding higher hazards were 10% and 21% (HR = 1.10 [1.02-1.20]; HR = 1.21 [1.04-1.41]), while hazards of symptom-state reversion were 17% and 26% lower (HR = 0.83 [0.76-0.91]; HR = 0.74 [0.63-0.87]). Significant additive interactions between CMM and unhealthy sleep duration were observed (P for additive interaction <0.001). CONCLUSIONS: CMM is associated with higher hazards of DS onset and lower hazards of transitioning from DS to non-DS. Compared with individuals with good sleep duration, these associations were stronger among those with poor sleep duration.