Journal of Behavioral Medicine

, Volume 38, Issue 2, pp 204–213 | Cite as

Rumination mediates the relationships between depressed mood and both sleep quality and self-reported health in young adults

  • Danica C. Slavish
  • Jennifer E. Graham-EngelandEmail author


The psychological mechanisms by which depressed mood can lead to impaired sleep and poorer overall health remain unclear. The goal of this study was to investigate the extent to which a tendency to ruminate accounts for the associations between depressed mood and both sleep quality and self-reported health in 165 healthy young adults. Self-reported assessments of anxiety, depressed mood, rumination, sleep quality, and general health were collected at two different time points approximately 2 months apart. Structural equation modeling revealed that rumination measured at the earlier time point mediated the relationships between depressed mood and both sleep quality and health, all measured at the later time point, in a model that was a good fit to the data overall, χ2 (50, N = 165) = 103.08, p < 0.001; RMSEA = 0.08 (0.06–0.10), TLI = 0.91, CFI = 0.94. Results were similar whether or not anxiety was controlled. Results indicate that rumination may be a psychological mechanism by which negative mood leads to impaired sleep and poorer perceived health.


Rumination Anxiety Depressed mood Sleep quality Perceived health 



This research was supported in part by a grant from The Pennsylvania State University Social Science Research Institute, Level 1 Funding and by the National Science Foundation under Grant No. DGE1255832. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author and do not necessarily reflect the views of the National Science Foundation.

Conflict of interest

The authors Danica C. Slavish and Jennifer E. Graham-Engeland declare no conflict of interest.

Human and Animal Rights and Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all participants included in the study.


  1. Ayas, N. T., White, D. P., Al-Delaimy, W. K., Manson, J. E., Stampfer, M. J., Speizer, F. E., et al. (2003). A prospective study of self-reported sleep duration and incident diabetes in women. Diabetes Care, 26, 380–384.CrossRefPubMedGoogle Scholar
  2. Baglioni, C., Spiegelhalder, K., Lombardo, C., & Riemann, D. (2010). Sleep and emotions: A focus on insomnia. Sleep Medicine Reviews, 14, 227–238.CrossRefPubMedGoogle Scholar
  3. Benca, R. M., Obermeyer, W. H., Thisted, R. A., & Gillin, J. C. (1992). Sleep and psychiatric disorders: A meta-analysis. Archives of General Psychiatry, 49, 651.CrossRefPubMedGoogle Scholar
  4. Bentler, P. M. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107, 238.CrossRefPubMedGoogle Scholar
  5. Bosch, J. A. (2014). The use of saliva markers in psychobiology: Mechanisms and methods. Diagnostics and Disorders, 24, 99–108.Google Scholar
  6. Brosschot, J. F., Gerin, W., & Thayer, J. F. (2006). The perseverative cognition hypothesis: A review of worry, prolonged stress-related physiological activation, and health. Journal of Psychosomatic Research, 60, 113–124.CrossRefPubMedGoogle Scholar
  7. Brosschot, J. F., Verkuil, B., & Thayer, J. F. (2010). Conscious and unconscious perseverative cognition: Is a large part of prolonged physiological activity due to unconscious stress? Journal of Psychosomatic Research, 69, 407–416.CrossRefPubMedGoogle Scholar
  8. Buboltz, W., Brown, F., & Soper, B. (2001). Sleep habits and patterns of college students: A preliminary study. Journal of American College Health, 50, 131–135.CrossRefPubMedGoogle Scholar
  9. Butler, L. D., & Nolen-Hoeksema, S. (1994). Gender differences in responses to depressed mood in a college sample. Sex Roles, 30, 331–346.CrossRefGoogle Scholar
  10. Buysse, D. J., Hall, M. L., Strollo, P. J., Kamarck, T. W., Owens, J., Lee, L., et al. (2008). Relationships between the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and clinical/polysomnographic measures in a community sample. Journal of Clinical Sleep Medicine, 4, 563.PubMedCentralPubMedGoogle Scholar
  11. Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28, 193–213.CrossRefPubMedGoogle Scholar
  12. Byrne, B. M. (2001). Structural equation modeling with AMOS. Mahwah, NJ: Lawrence Erlbaum.Google Scholar
  13. Carstensen, L. L., Fung, H. H., & Charles, S. T. (2003). Socioemotional selectivity theory and the regulation of emotion in the second half of life. Motivation and Emotion, 27, 103–123.CrossRefGoogle Scholar
  14. Charles, S. T., Piazza, J. R., Luong, G., & Almeida, D. M. (2009). Now you see it, now you don’t: Age differences in affective reactivity to social tensions. Psychology and Aging, 24, 645–653.CrossRefPubMedCentralPubMedGoogle Scholar
  15. Dowlati, Y., Herrmann, N., Swardfager, W., Liu, H., Sham, L., Reim, E. K., et al. (2010). A meta-analysis of cytokines in major depression. Biological Psychiatry, 67, 446–457.CrossRefPubMedGoogle Scholar
  16. Gaskin, M. E., Greene, A. F., Robinson, M. E., & Geisser, M. E. (1992). Negative affect and the experience of chronic pain. Journal of Psychosomatic Research, 36, 707–713.CrossRefPubMedGoogle Scholar
  17. Gaultney, J. F. (2010). The prevalence of sleep disorders in college students: Impact on academic performance. Journal of American College Health, 59, 91–97.CrossRefPubMedGoogle Scholar
  18. Gerin, W., Zawadzki, M. J., Brosschot, J. F., Thayer, J. F., Christenfeld, N. J., Campbell, T. S., & Smyth, J. M. (2012). Rumination as a mediator of chronic stress effects on hypertension: A causal model. International Journal of Hypertension, 2012, 1–9.Google Scholar
  19. Goldstein, T. R., Bridge, J. A., & Brent, D. A. (2008). Sleep disturbance preceding completed suicide in adolescents. Journal of Consulting and Clinical Psychology, 76, 84.CrossRefPubMedCentralPubMedGoogle Scholar
  20. Gottlieb, D. J., Redline, S., Nieto, F. J., Baldwin, C. M., Newman, A. B., Resnick, H. E., et al. (2006). Association of usual sleep duration with hypertension: The sleep heart health study. Sleep Medicine Reviews, 29, 1009.Google Scholar
  21. Graham, J. E., & Streitel, K. L. (2010). Sleep quality and acute pain severity among young adults with and without chronic pain: The role of biobehavioral factors. Journal of Behavioral Medicine, 33, 335–345.CrossRefPubMedGoogle Scholar
  22. Guastella, A. J., & Moulds, M. L. (2007). The impact of rumination on sleep quality following a stressful life event. Personality and Individual Differences, 42, 1151–1162.CrossRefGoogle Scholar
  23. Ham, L. S., & Hope, D. A. (2003). College students and problematic drinking: A review of the literature. Clinical Psychology Review, 23, 719–759.CrossRefPubMedGoogle Scholar
  24. Hann, D., Winter, K., & Jacobsen, P. (1999). Measurement of depressive symptoms in cancer patients: Evaluation of the Center for Epidemiological Studies Depression scale (CES-D). Journal of Psychosomatic Research, 46, 437–443.CrossRefPubMedGoogle Scholar
  25. Harvey, A. G. (2001). Insomnia: Symptom or diagnosis? Clinical Psychology Review, 21, 1037–1059.CrossRefPubMedGoogle Scholar
  26. Hayduk, L., Cummings, G. G., Boadu, K., Pazderka-Robinson, H., & Boulianne, S. (2007). Testing! Testing! One, two three—Testing the theory in structural equation models. Personality and Individual Differences, 42, 841–850.Google Scholar
  27. Hicks, R. A., Fernandez, C., & Pellegrini, R. J. (2001). Striking changes in the sleep satisfaction of university students over the last two decades. Perceptual and Motor Skills, 93, 660.CrossRefPubMedGoogle Scholar
  28. Hooper, D., Coughlan, J., & Mullen, M. (2008). Structural equation modelling: Guidelines for determining model fit. Articles, 2.Google Scholar
  29. Hu, L., & Bentler, P. M. (1998). Fit indices in covariance structural modeling: Sensitivity to underparameterized model misspecification. Psychological Methods, 3, 424–453.CrossRefGoogle Scholar
  30. Jean-Louis, G., Gizycki, H. V., Zizi, F., & Nunes, J. (1998). Mood states and sleepiness in college students: Influences of age, sex, habitual sleep, and substance use. Perceptual and Motor Skills, 87, 507–512.CrossRefPubMedGoogle Scholar
  31. Kiecolt-Glaser, J. K., & Glaser, R. (2002). Depression and immune function: Central pathways to morbidity and mortality. Journal of Psychosomatic Research, 53, 873–876.CrossRefPubMedGoogle Scholar
  32. Kline, R. B. (2005). Principles and practice of structural equation modeling (2nd ed.). New York, NY: The Guilford Press.Google Scholar
  33. Knutson, K. L., Spiegel, K., Penev, P., & Van Cauter, E. (2007). The metabolic consequences of sleep deprivation. Sleep Medicine Reviews, 11, 163–178.CrossRefPubMedCentralPubMedGoogle Scholar
  34. Kuehner, C., & Buerger, C. (2005). Determinants of subjective quality of life in depressed patients: The role of self-esteem, response styles, and social support. Journal of Affective Disorders, 86, 205–213.CrossRefPubMedGoogle Scholar
  35. Little, T. D., Cunningham, W. A., Shahar, G., & Widaman, K. F. (2002). To parcel or not to parcel: Exploring the question, weighing the merits. Structural Equation Modeling, 9, 151–173.CrossRefGoogle Scholar
  36. Liu, X., & Buysse, D. J. (2006). Sleep and youth suicidal behavior: A neglected field. Current Opinion in Psychiatry, 19, 288–293.CrossRefPubMedGoogle Scholar
  37. MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G., & Sheets, V. (2002). A comparison of methods to test mediation and other intervening variable effects. Psychological Methods, 7, 83–104.CrossRefPubMedCentralPubMedGoogle Scholar
  38. Maes, M., Bosmans, E., Meltzer, H. Y., Scharpe, S., & Suy, E. (1993). Interleukin-1 beta: A putative mediator of HPA axis hyperactivity in major depression? American Journal of Psychiatry, 150, 1189–1193.CrossRefPubMedGoogle Scholar
  39. McCurry, S. M., & Ancoli-Israel, S. (2003). Sleep dysfunction in Alzheimer’s disease and other dementias. Current Treatment Options in Neurology, 5, 261–272.CrossRefPubMedGoogle Scholar
  40. Mednick, S. C., Christakis, N. A., & Fowler, J. H. (2010). The spread of sleep loss influences drug use in adolescent social networks. PLoS One, 5, e9775.Google Scholar
  41. Mika, J., Zychowska, M., Popiolek-Barczyk, K., Rojewska, E., & Przewlocka, B. (2013). Importance of glial activation in neuropathic pain. European Journal of Pharmacology, 716, 106–119.CrossRefPubMedGoogle Scholar
  42. Möller-Levet, C. S., Archer, S. N., Bucca, G., Laing, E. E., Slak, A., Kabiljo, R., et al. (2013). Effects of insufficient sleep on circadian rhythmicity and expression amplitude of the human blood transcriptome. Proceedings of the National Academy of Sciences, 110, E1132–E1141.CrossRefGoogle Scholar
  43. Mosko, S., Zetin, M., Glen, S., Garber, D., Deantonio, M., Sassin, J., et al. (1989). Self-reported depressive symptomatology, mood ratings, and treatment outcome in sleep disorders patients. Journal of Clinical Psychology, 45, 51–60.CrossRefPubMedGoogle Scholar
  44. Motivala, S. J., Sarfatti, A., Olmos, L., & Irwin, M. R. (2005). Inflammatory markers and sleep disturbance in major depression. Psychosomatic Medicine, 67, 187–194.CrossRefPubMedGoogle Scholar
  45. Mullington, J. M., Haack, M., Toth, M., Serrador, J. M., & Meier-Ewert, H. K. (2009). Cardiovascular, inflammatory, and metabolic consequences of sleep deprivation. Progress in Cardiovascular Diseases, 51, 294–302.CrossRefPubMedCentralPubMedGoogle Scholar
  46. National Sleep Foundation. (2008). 2008 sleep in America poll. Washington, DC: National Sleep Foundation.Google Scholar
  47. Nolen-Hoeksema, S. (2000). The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. Journal of Abnormal Psychology, 109, 504–511.CrossRefPubMedGoogle Scholar
  48. Nolen-Hoeksema, S., & Morrow, J. (1991). A prospective study of depression and posttraumatic stress symptoms after a natural disaster: The 1989 Loma Prieta earthquake. Journal of Personality and Social Psychology, 61, 115–121.CrossRefPubMedGoogle Scholar
  49. Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on Psychological Science, 3, 400–424.CrossRefGoogle Scholar
  50. O’Malley, P. M. (2004). Maturing out of problematic alcohol use. Alcohol Research and Health, 28, 202.Google Scholar
  51. Pariante, C. M., & Lightman, S. L. (2008). The HPA axis in major depression: Classical theories and new developments. Trends in Neurosciences, 31, 464–468.CrossRefPubMedGoogle Scholar
  52. Patel, S. R., & Hu, F. B. (2008). Short sleep duration and weight gain: A systematic review. Obesity, 16, 643–653.CrossRefPubMedCentralPubMedGoogle Scholar
  53. Punjabi, N. M., & Polotsky, V. Y. (2005). Disorders of glucose metabolism in sleep apnea. Journal of Applied Physiology, 99, 1998–2007.CrossRefPubMedGoogle Scholar
  54. Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.CrossRefGoogle Scholar
  55. Roehrs, T., & Roth, T. (2001). Sleep, sleepiness, sleep disorders and alcohol use and abuse. Sleep Medicine Reviews, 5, 287–297.CrossRefPubMedGoogle Scholar
  56. Rosa, R. R., Bonnet, M. H., & Kramer, M. (1983). The relationship of sleep and anxiety in anxious subjects. Biological Psychology, 16, 119–126.CrossRefPubMedGoogle Scholar
  57. Sadeh, A., Keinan, G., & Daon, K. (2004). Effects of stress on sleep: The moderating role of coping style. Health Psychology, 23, 542–545.CrossRefPubMedGoogle Scholar
  58. Salovey, P., Rothman, A. J., Detweiler, J. B., & Steward, W. T. (2000). Emotional states and physical health. American Psychologist, 55, 110.CrossRefPubMedGoogle Scholar
  59. Sansone, R. A., & Sansone, L. A. (2012). Rumination: Relationships with physical health. Innovations in Clinical Neuroscience, 9, 29–34.PubMedCentralPubMedGoogle Scholar
  60. Shackman, A. J., Salomons, T. V., Slagter, H. A., Fox, A. S., Winter, J. J., & Davidson, R. J. (2011). The integration of negative affect, pain and cognitive control in the cingulate cortex. Nature Reviews Neuroscience, 12, 154–167.CrossRefPubMedCentralPubMedGoogle Scholar
  61. Simon, G. E. (2003). Social and economic burden of mood disorders. Biological Psychiatry, 54, 208–215.CrossRefPubMedGoogle Scholar
  62. Smith, M. T., & Haythornthwaite, J. A. (2004). How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature. Sleep Medicine Reviews, 8, 119–132.CrossRefPubMedGoogle Scholar
  63. Spiegel, K., Knutson, K., Leproult, R., Tasali, E., & Van Cauter, E. (2005). Sleep loss: A novel risk factor for insulin resistance and type 2 diabetes. Journal of Applied Physiology, 99, 2008–2019.CrossRefPubMedGoogle Scholar
  64. Spielberger, C. D., Gorsuch, R. L., Lushene, P. R., Vagg, P. R., & Jacobs, G. A. (1983). Manual for the state-trait anxiety inventory (form Y). Redwood City, CA: Mind Garden.Google Scholar
  65. Steiger, J. H. (2007). Understanding the limitations of global fit assessment in structural equation modeling. Personality and Individual Differences, 42, 893–898.CrossRefGoogle Scholar
  66. Steiger, J. H., & Lind, J. C. (1980). Statistically-based tests for the number of common factors. Paper presented at the Psychometric Society, Iowa City, IA.Google Scholar
  67. Takano, K., & Tanno, Y. (2009). Self-rumination, self-reflection, and depression: Self-rumination counteracts the adaptive effect of self-reflection. Behaviour Research and Therapy, 47, 260–264.CrossRefPubMedGoogle Scholar
  68. Thomsen, D. K., Mehlsen, M. Y., Olesen, F., Hokland, M., Viidik, A., Avlund, K., et al. (2004). Is there an association between rumination and self-reported physical health? A one-year follow-up in a young and an elderly sample. Journal of Behavioral Medicine, 27, 215–231.CrossRefPubMedGoogle Scholar
  69. Thomsen, D. K., Yung Mehlsen, M., Christensen, S., & Zachariae, R. (2003). Rumination—Relationship with negative mood and sleep quality. Personality and Individual Differences, 34, 1293–1301.CrossRefGoogle Scholar
  70. Tsypes, A., Aldao, A., & Mennin, D. S. (2013). Emotion dysregulation and sleep difficulties in generalized anxiety disorder. Journal of Anxiety Disorders, 27, 197–203.CrossRefPubMedGoogle Scholar
  71. Tucker, L. R., & Lewis, C. (1973). A reliability coefficient for maximum likelihood factor analysis. Psychometrika, 38, 1–10.CrossRefGoogle Scholar
  72. Van Moffaert, M. M. M. P. (1994). Sleep disorders and depression: The ‘chicken and egg’ situation. Journal of Psychosomatic Research, 38, 9–13.CrossRefPubMedGoogle Scholar
  73. Walker, M. P., & van Der Helm, E. (2009). Overnight therapy? The role of sleep in emotional brain processing. Psychological Bulletin, 135, 731.CrossRefPubMedCentralPubMedGoogle Scholar
  74. Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-item-short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care, 30, 473–483.CrossRefPubMedGoogle Scholar
  75. Weitzman, E. R. (2004). Poor mental health, depression, and associations with alcohol consumption, harm, and abuse in a national sample of young adults in college. The Journal of Nervous and Mental Disease, 192, 269–277.CrossRefPubMedGoogle Scholar
  76. West, S. G., Taylor, A. B., & Wu, W. (2012). Model fit and model selection in structural equation modeling. Handbook of structural equation modeling (pp. 209–231). New York, NY: Guilford.Google Scholar
  77. Zawadzki, M. J., Graham, J. E., & Gerin, W. (2013). Rumination and anxiety mediate the effect of loneliness on depressed mood and sleep quality in college students. Health Psychology, 32, 212–222.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Danica C. Slavish
    • 1
  • Jennifer E. Graham-Engeland
    • 1
    Email author
  1. 1.219 Department of Biobehavioral HealthThe Pennsylvania State UniversityUniversity ParkUSA

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