Association of sleep quality and its change with the risk of depression in middle-aged and elderly people: A 10-year cohort study from England

Background: Persistently poor sleep quality in young adults is linked to a higher risk of depression. However, the impact of changes in sleep quality on depression risk in middle-aged and older adults remain unclear. This study investigates the association between sleep quality, its changes, and the risk of depression in middle-aged and elderly people. Methods: We included 4007 participants (mean age 63.0 +/- 7.6 years, 53.0 % women) from the English Longitudinal Study of Ageing. Sleep quality was assessed using the Jenkins Sleep Problems Scale and a global sleep quality question. Depression was evaluated with the Center for Epidemiological Studies Depression Scale and self-reported doctor-diagnosed depression. Multivariable logistic regression, restricted cubic spline curve, and mediation analysis was employed. Results: After 10 years of follow-up, 777 individuals developed depression. Sleep quality scores positively correlated with depression risk. Among those with good sleep quality, worsening sleep quality increased depression risk (OR = 1.67, 95 % CI: 1.21-2.31). For those with intermediate sleep quality, improved sleep quality reduced depression risk (OR = 0.70, 95 % CI: 0.50-0.98). Conversely, worsening sleep quality increased depression risk (OR = 2.11, 95 % CI: 1.47-3.02). Pain and functional disability partially mediated the association between intermediate/poor sleep quality and depression (9.8 % and 4.2 %, respectively). Limitations: Sleep quality is based on self-reported. Conclusions: Intermediate, poor, and worsening sleep quality are linked to higher depression risk. Improving sleep quality mitigates depression risk in those with intermediate sleep quality. Sleep quality may influence depression indirectly through pain and functional disability.