Association of Sleep Health Metrics (Sleep Duration and Quality) and Mental Health Status: A Population-Based Cross-Sectional Survey
-
Amirhossein Shahsavand
,
Keyvan Karimi
,
Reza Samiee
,
Mehran Saberian
,
Yosra Azizpour
,
khosro Sadeghniiat
,
Arezu Najafi
Abstract
Background: Sleep pattern is a vital part of healthy lifestyle, with deviations from the recommended 7-9 hours associated to negative outcomes. Limited studies have investigated the connection between sleep patterns and mental health in underserved urban communities. This study explores the association between sleep health metrics, such as sleep duration and mental health among the population residing in Southern Tehran.
Methods: This population-based cross-sectional study has utilized data from 1,311 participants of the "Study Protocol and Lessons from Iran for the Integrated and Repeated Public Health Surveillance System (IRPHS) " telephone survey participants to evaluate amount of sleep duration (<7h and ≥9h) and sleep quality, as well as their associations with anxiety, depression, suicidal ideation, and related sociodemographic factors.
Result: The mean (standard deviation) age of participants was 40.4 ± 13.4 years, and 60.4% of the sample was female. Among our participants 15.0% had insufficient sleep (<7h) and 18.5% had long sleep duration (≥9h). Sex, socioeconomic status, and tobacco use were associated with sleep duration (p < 0.05). Moderate and high anxiety, moderate depression, and high suicidal ideation were associated with long sleep (p < 0.05).
Conclusion: In southern Tehran population, prevalence of both insufficient and long sleep duration is high. Poor sleep quality and oversleeping can happen due to underlying depression and anxiety, and targeting improvement of mental health can increase sleep hygiene. The findings provide insights for prevention strategies tailored to the study.
References:
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20. Kaneita Y, Uchiyama M, Yoshiike N, Ohida T. Associations of Usual Sleep Duration with Serum Lipid and Lipoprotein Levels. Sleep. 2008;31(5):645-52.
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27. Harvey AG. A Transdiagnostic Approach to Treating Sleep Disturbance in Psychiatric Disorders. Cognitive Behaviour Therapy. 2009;38(sup1):35-42.
28. Azizpour Y, Ehsani R, Karimi K, Olyaeemanesh A, Delavari A, Vosoogh-Moghaddam A, et al. Developing a Pilot Study Protocol and Lessons from Iran for the Integrated and Repeated Public Health Surveillance System (IRPHS). 2025 (Unpublished).
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31. Ahmadi SM, Masjedi Arani A, Bakhtiari M, Emamy M. Psychometric Properties of Persian Version of Patient Health Questionnaires-4 (PHQ-4) in Coronary Heart Disease Patients. Iranian Journal of Psychiatry and Behavioral Sciences. 2020;13.
32. Mohamadian R, Khazaie H, Ahmadi SM, Fatmizade M, Ghahremani S, Sadeghi H, et al. The Psychometric Properties of the Persian Versions of the Patient Health Questionnaires 9 and 2 as Screening Tools for Detecting Depression among University Students. Int J Prev Med. 2022;13:116.
33. Kihç C, Rezaki M, Rezaki B, Kaplan I, Özgen G, Sagduyu A, et al. General Health Questionnaire (GHQ12 & GHQ28): psychometric properties and factor structure of the scales in a Turkish primary care sample. Social Psychiatry and Psychiatric Epidemiology. 1997;32(6):327-31.
34. Khazaie H, Jalali A, Khazaie A, Mohammadi R, Jalali R, Moheb SB, et al. The prevalence of sleep disorders in Iranian adults - an epidemiological study. BMC Public Health. 2024;24(1):3141.
35. Najafi A, Akbarpour S, Najafi F, Safari-Faramani R, Sadeghniiat-Haghighi K, Aghajani F, et al. Prevalence of short and long sleep duration: Ravansar NonCommunicable Disease (RaNCD) cohort study. BMC Public Health. 2022;22(1):1631.
36. Willoughby AR, Alikhani I, Karsikas M, Chua XY, Chee MWL. Country differences in nocturnal sleep variability: Observations from a large-scale, long-term sleep wearable study. Sleep Medicine. 2023;110:155-65.
37. Al-Thani MA, Khaled SM. The relationship between sleep duration and health status in Qatar's population. Public Health Pract (Oxf). 2020;1:100056.
38. Kerkhof GA. Epidemiology of sleep and sleep disorders in The Netherlands. Sleep Medicine. 2017;30:229-39.
39. Pankowska MM, Lu H, Wheaton AG, Liu Y, Lee B, Greenlund KJ, et al. Prevalence and Geographic Patterns of Self-Reported Short Sleep Duration Among US Adults, 2020. Prev Chronic Dis. 2023;20:220400.
40. Ahmed AE, Al-Jahdali F, Al AA, Abuabat F, Bin Salih SA, Al-Harbi A, et al. Prevalence of sleep duration among Saudi adults. Saudi Med J. 2017;38(3):276-83.
41. Metse AP, Bowman JA. Prevalence of self-reported suboptimal sleep in Australia and receipt of sleep care: results from the 2017 National Social Survey. Sleep Health. 2020;6(1):100-9.
42. Krueger PM, Friedman EM. Sleep duration in the United States: a cross-sectional population-based study. Am J Epidemiol. 2009;169(9):1052-63.
43. Grandner MA, Patel NP, Gehrman PR, Xie D, Sha D, Weaver T, et al. Who gets the best sleep? Ethnic and socioeconomic factors related to sleep complaints. Sleep Med. 2010;11(5):470-8.
44. Mong JA, Cusmano DM. Sex differences in sleep: impact of biological sex and sex steroids. Philos Trans R Soc Lond B Biol Sci. 2016;371(1688):20150110.
45. Alosta MR, Oweidat I, Alsadi M, Alsaraireh MM, Oleimat B, Othman EH. Predictors and disturbances of sleep quality between men and women: results from a cross-sectional study in Jordan. BMC Psychiatry. 2024;24(1):200.
46. Scott AJ, Webb TL, Martyn-St James M, Rowse G, Weich S. Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials. Sleep Med Rev. 2021;60:101556.
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48. Shen C, Mireku MO, Di Simplicio M, Dumontheil I, Thomas MSC, Röösli M, et al. Bidirectional associations between sleep problems and behavioural difficulties and health-related quality of life in adolescents: Evidence from the SCAMP longitudinal cohort study. JCPP Adv. 2022;2(3):e12098.
49. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet Psychiatry. 2022;9(2):137-50.
50. Ghalichi L, Shariat SV, Naserbakht M, Taban M, Abbasi-Kangevari M, Afrashteh F, et al. National and subnational burden of mental disorders in Iran (1990–2019): findings of the Global Burden of Disease 2019 study. The Lancet Global Health. 2024;12(12):e1984-e92.
51. Chaput J-P, Dutil C, Featherstone R, Ross R, Giangregorio L, Saunders TJ, et al. Sleep duration and health in adults: an overview of systematic reviews. Applied Physiology, Nutrition, and Metabolism. 2020;45(10 (Suppl. 2)):S218-S31.
52. Buxton OM, Marcelli E. Short and long sleep are positively associated with obesity, diabetes, hypertension, and cardiovascular disease among adults in the United States. Social Science & Medicine. 2010;71(5):1027-36.
53. Nutt D, Wilson S, Paterson L. Sleep disorders as core symptoms of depression. Dialogues Clin Neurosci. 2008;10(3):329-36.
54. Zhang J, He M, Wang X, Jiang H, Huang J, Liang S. Association of sleep duration and risk of mental disorder: a systematic review and meta-analysis. Sleep Breath. 2024;28(1):261-80.
55. Zhang J, He M, Wang X, Jiang H, Huang J, Liang S. Association of sleep duration and risk of mental disorder: a systematic review and meta-analysis. Sleep Breath. 2024;28(1):261-80.
56. Zhou L, Zhang H, Luo Z, Liu X, Yang L, Hu H, et al. Abnormal night sleep duration and inappropriate sleep initiation time are associated with elevated anxiety symptoms in Chinese rural adults: the Henan Rural Cohort. Psychiatry Research. 2020;291:113232.
57. Ayers N, McCall WV, Miller BJ. Sleep Problems, Suicidal Ideation, and Psychopathology in First-Episode Psychosis. Schizophr Bull. 2024;50(2):286-94.
58. Duan H, Qin K, Hu L, Liu B, Su G, Zhang H, et al. Association between sleep duration, suicidal ideation, suicidal attempt and suicidal behavior among Chinese adolescents. J Affect Disord. 2024;363:348-57.
59. Goodwin RD, Marusic A. Association between short sleep and suicidal ideation and suicide attempt among adults in the general population. Sleep. 2008;31(8):1097-101.
1. Chaput JP, Gray CE, Poitras VJ, Carson V, Gruber R, Olds T, et al. Systematic review of the relationships between sleep duration and health indicators in school-aged children and youth. Appl Physiol Nutr Metab. 2016;41(6 Suppl 3):S266-82.
2. Chaput JP, Gray CE, Poitras VJ, Carson V, Gruber R, Birken CS, et al. Systematic review of the relationships between sleep duration and health indicators in the early years (0-4 years). BMC Public Health. 2017;17(Suppl 5):855.
3. St-Onge MP, Grandner MA, Brown D, Conroy MB, Jean-Louis G, Coons M, et al. Sleep Duration and Quality: Impact on Lifestyle Behaviors and Cardiometabolic Health: A Scientific Statement From the American Heart Association. Circulation. 2016;134(18):e367-e86.
4. Gruber R, Carrey N, Weiss SK, Frappier JY, Rourke L, Brouillette RT, et al. Position statement on pediatric sleep for psychiatrists. J Can Acad Child Adolesc Psychiatry. 2014;23(3):174-95.
5. Buysse DJ. Sleep health: can we define it? Does it matter? Sleep. 2014;37(1):9-17.
6. Du Y, Wang M, Wang Y, Dou Y, Yan Y, Fan H, et al. The association between dietary quality, sleep duration, and depression symptoms in the general population: findings from cross-sectional NHANES study. BMC Public Health. 2024;24(1):2588.
7. Chaput JP, Dutil C, Sampasa-Kanyinga H. Sleeping hours: what is the ideal number and how does age impact this? Nat Sci Sleep. 2018;10:421-30.
8. Harvey AG, Murray G, Chandler RA, Soehner A. Sleep disturbance as transdiagnostic: Consideration of neurobiological mechanisms. Clinical Psychology Review. 2011;31(2):225-35.
9. Regier DA, Kuhl EA, Narrow WE, Kupfer DJ. Research planning for the future of psychiatric diagnosis. Eur Psychiatry. 2012;27(7):553-6.
10. Bixler E. Sleep and society: an epidemiological perspective. Sleep Med. 2009;10 Suppl 1:S3-6.
11. Devore EE, Grodstein F, Schernhammer ES. Sleep Duration in Relation to Cognitive Function among Older Adults: A Systematic Review of Observational Studies. Neuroepidemiology. 2016;46(1):57-78.
12. Lee M-S, Shin J-S, Lee J, Lee YJ, Kim M-r, Park KB, et al. The association between mental health, chronic disease and sleep duration in Koreans: a cross-sectional study. BMC Public Health. 2015;15(1):1200.
13. Cappuccio FP, D'Elia L, Strazzullo P, Miller MA. Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep. 2010;33(5):585-92.
14. Besedovsky L, Lange T, Born J. Sleep and immune function. Pflugers Arch. 2012;463(1):121-37.
15. Singh M, Drake Christopher L, Roehrs T, Hudgel David W, Roth, Thomas. The Association Between Obesity and Short Sleep Duration: A Population-Based Study. Journal of Clinical Sleep Medicine. 2005;01(04):357-63.
16. Adámková V, Hubáček JA, Lánská V, Vrablík M, Králová Lesná I, Suchánek P, et al. Association between duration of the sleep and body weight. Physiol Res. 2009;58 Suppl 1:S27-s31.
17. Gottlieb DJ, Redline S, Nieto FJ, Baldwin CM, Newman AB, Resnick HE, et al. Association of Usual Sleep Duration With Hypertension: The Sleep Heart Health Study. Sleep. 2006;29(8):1009-14.
18. Cappuccio FP, Cooper D, D'Elia L, Strazzullo P, Miller MA. Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. European Heart Journal. 2011;32(12):1484-92.
19. Shan Z, Ma H, Xie M, Yan P, Guo Y, Bao W, et al. Sleep Duration and Risk of Type 2 Diabetes: A Meta-analysis of Prospective Studies. Diabetes Care. 2015;38(3):529-37.
20. Kaneita Y, Uchiyama M, Yoshiike N, Ohida T. Associations of Usual Sleep Duration with Serum Lipid and Lipoprotein Levels. Sleep. 2008;31(5):645-52.
21. Heslop P, Smith GD, Metcalfe C, Macleod J, Hart C. Sleep duration and mortality: The effect of short or long sleep duration on cardiovascular and all-cause mortality in working men and women. Sleep Med. 2002;3(4):305-14.
22. Ferrie JE, Shipley MJ, Cappuccio FP, Brunner E, Miller MA, Kumari M, et al. A prospective study of change in sleep duration: associations with mortality in the Whitehall II cohort. Sleep. 2007;30(12):1659-66.
23. Rasch B, Born J. About Sleep's Role in Memory. Physiological Reviews. 2013;93(2):681-766.
24. Walker MP. The role of sleep in cognition and emotion. Ann N Y Acad Sci. 2009;1156:168-97.
25. Kahn M, Sheppes G, Sadeh A. Sleep and emotions: Bidirectional links and underlying mechanisms. International Journal of Psychophysiology. 2013;89(2):218-28.
26. Kupfer D, Foster FG. INTERVAL BETWEEN ONSET OF SLEEP AND RAPID-EYE-MOVEMENT SLEEP AS AN INDICATOR OF DEPRESSION. The Lancet. 1972;300(7779):684-6.
27. Harvey AG. A Transdiagnostic Approach to Treating Sleep Disturbance in Psychiatric Disorders. Cognitive Behaviour Therapy. 2009;38(sup1):35-42.
28. Azizpour Y, Ehsani R, Karimi K, Olyaeemanesh A, Delavari A, Vosoogh-Moghaddam A, et al. Developing a Pilot Study Protocol and Lessons from Iran for the Integrated and Repeated Public Health Surveillance System (IRPHS). 2025 (Unpublished).
29. Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L, et al. National Sleep Foundation's sleep time duration recommendations: methodology and results summary. Sleep Health. 2015;1(1):40-3.
30. Scott H, Naik G, Lechat B, Manners J, Fitton J, Nguyen DP, et al. Are we getting enough sleep? Frequent irregular sleep found in an analysis of over 11 million nights of objective in-home sleep data. Sleep Health. 2024;10(1):91-7.
31. Ahmadi SM, Masjedi Arani A, Bakhtiari M, Emamy M. Psychometric Properties of Persian Version of Patient Health Questionnaires-4 (PHQ-4) in Coronary Heart Disease Patients. Iranian Journal of Psychiatry and Behavioral Sciences. 2020;13.
32. Mohamadian R, Khazaie H, Ahmadi SM, Fatmizade M, Ghahremani S, Sadeghi H, et al. The Psychometric Properties of the Persian Versions of the Patient Health Questionnaires 9 and 2 as Screening Tools for Detecting Depression among University Students. Int J Prev Med. 2022;13:116.
33. Kihç C, Rezaki M, Rezaki B, Kaplan I, Özgen G, Sagduyu A, et al. General Health Questionnaire (GHQ12 & GHQ28): psychometric properties and factor structure of the scales in a Turkish primary care sample. Social Psychiatry and Psychiatric Epidemiology. 1997;32(6):327-31.
34. Khazaie H, Jalali A, Khazaie A, Mohammadi R, Jalali R, Moheb SB, et al. The prevalence of sleep disorders in Iranian adults - an epidemiological study. BMC Public Health. 2024;24(1):3141.
35. Najafi A, Akbarpour S, Najafi F, Safari-Faramani R, Sadeghniiat-Haghighi K, Aghajani F, et al. Prevalence of short and long sleep duration: Ravansar NonCommunicable Disease (RaNCD) cohort study. BMC Public Health. 2022;22(1):1631.
36. Willoughby AR, Alikhani I, Karsikas M, Chua XY, Chee MWL. Country differences in nocturnal sleep variability: Observations from a large-scale, long-term sleep wearable study. Sleep Medicine. 2023;110:155-65.
37. Al-Thani MA, Khaled SM. The relationship between sleep duration and health status in Qatar's population. Public Health Pract (Oxf). 2020;1:100056.
38. Kerkhof GA. Epidemiology of sleep and sleep disorders in The Netherlands. Sleep Medicine. 2017;30:229-39.
39. Pankowska MM, Lu H, Wheaton AG, Liu Y, Lee B, Greenlund KJ, et al. Prevalence and Geographic Patterns of Self-Reported Short Sleep Duration Among US Adults, 2020. Prev Chronic Dis. 2023;20:220400.
40. Ahmed AE, Al-Jahdali F, Al AA, Abuabat F, Bin Salih SA, Al-Harbi A, et al. Prevalence of sleep duration among Saudi adults. Saudi Med J. 2017;38(3):276-83.
41. Metse AP, Bowman JA. Prevalence of self-reported suboptimal sleep in Australia and receipt of sleep care: results from the 2017 National Social Survey. Sleep Health. 2020;6(1):100-9.
42. Krueger PM, Friedman EM. Sleep duration in the United States: a cross-sectional population-based study. Am J Epidemiol. 2009;169(9):1052-63.
43. Grandner MA, Patel NP, Gehrman PR, Xie D, Sha D, Weaver T, et al. Who gets the best sleep? Ethnic and socioeconomic factors related to sleep complaints. Sleep Med. 2010;11(5):470-8.
44. Mong JA, Cusmano DM. Sex differences in sleep: impact of biological sex and sex steroids. Philos Trans R Soc Lond B Biol Sci. 2016;371(1688):20150110.
45. Alosta MR, Oweidat I, Alsadi M, Alsaraireh MM, Oleimat B, Othman EH. Predictors and disturbances of sleep quality between men and women: results from a cross-sectional study in Jordan. BMC Psychiatry. 2024;24(1):200.
46. Scott AJ, Webb TL, Martyn-St James M, Rowse G, Weich S. Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials. Sleep Med Rev. 2021;60:101556.
47. Yasugaki S, Okamura H, Kaneko A, Hayashi Y. Bidirectional relationship between sleep and depression. Neurosci Res. 2023.
48. Shen C, Mireku MO, Di Simplicio M, Dumontheil I, Thomas MSC, Röösli M, et al. Bidirectional associations between sleep problems and behavioural difficulties and health-related quality of life in adolescents: Evidence from the SCAMP longitudinal cohort study. JCPP Adv. 2022;2(3):e12098.
49. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet Psychiatry. 2022;9(2):137-50.
50. Ghalichi L, Shariat SV, Naserbakht M, Taban M, Abbasi-Kangevari M, Afrashteh F, et al. National and subnational burden of mental disorders in Iran (1990–2019): findings of the Global Burden of Disease 2019 study. The Lancet Global Health. 2024;12(12):e1984-e92.
51. Chaput J-P, Dutil C, Featherstone R, Ross R, Giangregorio L, Saunders TJ, et al. Sleep duration and health in adults: an overview of systematic reviews. Applied Physiology, Nutrition, and Metabolism. 2020;45(10 (Suppl. 2)):S218-S31.
52. Buxton OM, Marcelli E. Short and long sleep are positively associated with obesity, diabetes, hypertension, and cardiovascular disease among adults in the United States. Social Science & Medicine. 2010;71(5):1027-36.
53. Nutt D, Wilson S, Paterson L. Sleep disorders as core symptoms of depression. Dialogues Clin Neurosci. 2008;10(3):329-36.
54. Zhang J, He M, Wang X, Jiang H, Huang J, Liang S. Association of sleep duration and risk of mental disorder: a systematic review and meta-analysis. Sleep Breath. 2024;28(1):261-80.
55. Zhang J, He M, Wang X, Jiang H, Huang J, Liang S. Association of sleep duration and risk of mental disorder: a systematic review and meta-analysis. Sleep Breath. 2024;28(1):261-80.
56. Zhou L, Zhang H, Luo Z, Liu X, Yang L, Hu H, et al. Abnormal night sleep duration and inappropriate sleep initiation time are associated with elevated anxiety symptoms in Chinese rural adults: the Henan Rural Cohort. Psychiatry Research. 2020;291:113232.
57. Ayers N, McCall WV, Miller BJ. Sleep Problems, Suicidal Ideation, and Psychopathology in First-Episode Psychosis. Schizophr Bull. 2024;50(2):286-94.
58. Duan H, Qin K, Hu L, Liu B, Su G, Zhang H, et al. Association between sleep duration, suicidal ideation, suicidal attempt and suicidal behavior among Chinese adolescents. J Affect Disord. 2024;363:348-57.
59. Goodwin RD, Marusic A. Association between short sleep and suicidal ideation and suicide attempt among adults in the general population. Sleep. 2008;31(8):1097-101.
| Files | ||
| Issue | Vol 11 No 1 (2025): . | |
| Section | Articles | |
| Keywords | ||
| sleep anxiety depression suicide epidemiology sleep health sleep duration sleep quality | ||
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How to Cite
1.
Shahsavand A, Karimi K, Samiee R, Saberian M, Azizpour Y, Sadeghniiat khosro, Najafi A. Association of Sleep Health Metrics (Sleep Duration and Quality) and Mental Health Status: A Population-Based Cross-Sectional Survey. JBE. 2025;11(1):100-114.
