Abstract

Abstract Introduction There is a bidirectional relationship between sleep duration and mental health. This relationship may be impacted by race/ethnicity, indicating differential risk profiles across groups. Therefore, we aimed to determine whether race/ethnicity play a role in the relationship between sleep and mental health at the population level. Methods Data were used from adults age 18+ from the combined 2015-2020 (pre-pandemic) National Health and Nutrition Examination Survey (NHANES) (N=16,399). Habitual sleep duration was self-reported in half-hour increments and categorized as < 5h, 5.5-6.5h, 7-8h, 8.5-9.5h, or 10+h. Mental health symptoms in the past 2 weeks were reported as “not at all,” “several days,” “>half of days” or “nearly every day” and included depressed mood, anhedonia, feelings of guilt, appetite dysregulation, and suicide ideation. Race/ethnicity was self-reported as Non-Hispanic White (N=5499), Black/African-American (N=3975), Mexican-American (N=2337), Other Latinx (N=1846), Asian/Pacific-Islander (N=1984), or Multiracial/Other (N=758). Additional covariates included age and sex. NHANES sample weights were used for all analyses. Ordinal logistic regressions examined mental health outcomes associated with sleep duration stratified by race/ethnicity. Results Sleep duration by race/ethnicity interactions were seen for depression (p=0.006), guilt (p=0.009), appetite dysregulation (0.049), and suicide ideation (p< 0.0005), with a trend for anhedonia (p=0.185). Non-Hispanic Whites demonstrated U-shaped relationships with all mental health variables. Blacks/African-Americans demonstrated U-shaped relationships for depressed mood and anhedonia and relationships with short sleep for guilt, appetite, and suicide ideation. Mexican Americans demonstrated a U-shaped association with guilt and an association between long sleep and depressed mood, anhedonia, and suicide ideation. Other Latinx showed a U-shaped association with guilt and appetite, and long sleep relationships with depressed mood, anhedonia, and suicide ideation. Asians/Pacific-Islanders showed short sleep associations with depressed mood and appetite. Multiracial/Others showed a short sleep relationship with guilt and a long sleep relationship with suicide ideation. Conclusion Both short and long sleep duration were associated with worse mental health. However, this pattern of relationships depends on race/ethnicity, as different groups show different patterns of vulnerability. Future work should explore mechanisms of differential vulnerability and develop targeted interventions based on risk profile. Support (if any)

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