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. 2020 Oct 20:20:101225.
doi: 10.1016/j.pmedr.2020.101225. eCollection 2020 Dec.

Effects of tobacco addiction on links between early life adversities, sleep disturbance, and depression: A moderated mediation approach

Arwa Ben Salah  1 , Motohiro Nakajima  2 , Briana N DeAngelis  2 , Mustafa al'Absi  2
Affiliations

Effects of tobacco addiction on links between early life adversities, sleep disturbance, and depression: A moderated mediation approach

Arwa Ben Salah et al. Prev Med Rep. .

Abstract

Despite the well-established relationship between early life adversities (ELA) and depression, the underlying mechanisms for this link remain less clear and need to be developed. The aim of this study was to advance our understanding of this link by testing the mediating role of sleep disturbances and the moderating role of tobacco use in this mediation. A total of 579 smokers and non-smokers were recruited in two US communities (Duluth and Minneapolis, MN). Simple and moderated mediation analyses were performed using the PROCESS macro for SPSS, with the number of ELA as an independent variable, depression symptoms assessed by the Patient Health Questionnaire-9 (PHQ-9) as a dependent variable, sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI) as a mediator, and smoking status as a moderator variable. The study demonstrated that ELA and depressive symptoms were positively correlated; and sleep quality fully mediated this relationship. This mediation was moderated by tobacco use (index of moderated mediation = 0.10, 95%CI [0.03; 0.19]) and was more pronounced among smokers (b = 0.14, 95%CI [0.07; 0.23]) than non-smokers (b = 0.04, 95%CI [0.0002; 0.10]). Subsequent mediation analyses run separately for each component of the PSQI suggested that individuals who experienced ELA and who were smokers had greater delays in sleep onset and were more likely to sleep for a shorter duration, both of which predicted greater depressive symptoms. Sleep quality is therefore a promising ELA-related target for preventive and therapeutic interventions as well as for further research in depression and tobacco addiction.

Keywords: Addiction; Depression; Early life adversities; Sleep quality; Tobacco use.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Simple mediation (A), first stage (B) and second stage (C) moderated mediation models.
Fig. 2
Fig. 2
Simple mediation model: Indirect effect of early life adversities on depression through sleep dysfunction (n = 523).
See this image and copyright information in PMC

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