During the past year we have reported our findings of sex-specific associations between cigarette smoking and DSM-IV mood and anxiety disorders including full diagnosis, subthreshold and severe forms, symptoms, impairment and mental health services use using NHANES data. Female smokers showed statistically significant increased rates. Male adolescents showed little variation in depression and anxiety by smoking status. However, male smokers were more likely to seek mental health services. In the area of assessing biomarkers for mental disorders, we have examined a U-shaped association between sleep duration and self-reported cardiovascular diseases (CVD), as well as biological correlates of CVD. We divided adult respondents from NHANES 2005-08 surveys into short, normal, and long sleep groups. We found U-shaped associations of sleep duration with the risk quintiles of CVD biomarkers (including systolic blood pressure, C-reactive Protein (CRP), and urinary albumin-to-creatinine ratio (UACR)) and with CVD (congestive heart failure (CHF), heart attack, stroke and any CVD) in univariate analyses. After adjustment for demographic correlates, clinical and behavioral factors, long sleep duration was associated with risk quintile of CRP and stroke, while short sleep duration was associated with risk quintiles of SBP, Non-HDL-cholesterol and UACR, heart attack, stroke, and any CVD. Subgroup analyses revealed that the associations between short sleep duration and the high risk quintiles of SBP, stroke and any CVD occurred in females only (Zhang et al, under review). We have also examined demographic correlates, sleep and medical comorbidity, C-reactive protein level, and functional impairments in nonrestorative sleep and nocturnal insomnia symptoms among 10,908 respondents aged 20 years or older in NHANES 2005-2008 surveys. Respondents were divided into normal sleep, nocturnal insomnia symptoms (NIS)-only, nonrestorative sleep (NRS)-only, or NIS+NRS based on self-reported questions. NIS-only was associated with older age, lower family income and lower education level, whereas NRS-only was associated with younger age, higher family income and higher education level when referring to normal sleep. In addition, NIS-only was significantly associated with CVD, whereas NRS-only was associated with other primary sleep disorders (including habitual snoring, sleep apnea, and restless legs syndrome), respiratory diseases (emphysema and chronic bronchitis), thyroid disease and cancer as well as increased CRP level. NRS-only subjects reported poorer scores on the Functional Outcomes of Sleep Questionnaire (FOSQ) compared with those reporting normal sleep or NIS. The NIS+NRS group had more depressive symptoms, shorter sleep duration, more comorbidities and lower FOSQ score when compared with NIS or NRS groups (Zhang et al, under review). Public Health Impact: These findings provided evidence from the general population that there are associations between sleep duration and CVD and biomarkers in U.S. adults, particularly in females. The sex difference was also evident between insomnia subtypes in terms of sociodemographics, comorbidity of other sleep and physical disorders, increased CRP level, and functional impairments;and the elevated risk of mood and anxiety disorder was observed among smokers and was more pronounced in female smokers than that in male smokers. These results comprise significant steps in understanding the biologic mechanisms, identifying more homogeneous subgroups in clinical and genetic studies, and developing better clinical management and population intervention program. Future Plans Future analyses of the NHANES data will aim to 1) identify ethnic differences in manifestations of mental disorders in children;2) evaluate links between physical conditions and mental disorders, 3) examine the associations between biologic measures and the mental disorders, and 4) investigate the pattern of psychotropic medication use among children and adolescents.
