Residual Effects of Restless Sleep over Depressive Symptoms on Chronic Medical Conditions: Race by Gender Differences

  • Shervin Assari
  • Amanda Sonnega
  • Renee Pepin
  • Amanda Leggett



Sleep and depression are comorbid problems that contribute to the development of chronic medical conditions (CMC) over time. Although racial and gender differences in the bidirectional associations between sleep, depression, and CMC are known, very limited information exists on heterogeneity of the residual effects of sleep problems over depressive symptoms on CMC across race by gender groups.


Using a life-course perspective, the present study compared race by gender groups for residual effects of restless sleep over depressive symptoms on CMC.


We used data from waves 1 (year 1986), 4 (year 2001), and 5 (year 2011) of the Americans’ Changing Lives Study (ACL). The study followed 294 White men, 108 Black men, 490 White women, and 237 Black women for 25 years. Restless sleep, depressive symptoms (Center for Epidemiological Studies-Depression scale [CES-D]), and number of chronic medical conditions (hypertension, diabetes, chronic lung disease, heart disease, stroke, cancer, and arthritis) were measured in 1986, 2001, and 2011. We employed multi-group cross-lagged modeling, with chronic medical conditions as the outcome and race by gender as the groups.


Major group differences were found in the residual effect of restless sleep on CMC over depressive symptoms across race by gender groups. Restless sleep in 2001 predicted CMC 10 years later in 2011 among Black women (standardized adjusted B = .135, P < .05) and White men (standardized adjusted = .145, P < .01) and White women (standardized adjusted B = .171, P < .001) but not Black men (standardized adjusted B = .001, P > .05).


Race by gender heterogeneity in the residual effect of restless sleep over depressive symptoms on CMC over 25 years suggests that comorbid poor sleep and depressive symptoms differently contribute to development of multi-morbidity among subpopulations based on the intersection of race and gender. Thus, interventions that try to prevent comorbid sleep problems and depression as a strategy to prevent medical conditions may benefit from tailoring based on the intersection of race and gender.


Additive effect Residual effects Intersectionality Ethnic groups Sleep quality Depressive symptoms Chronic medical conditions 



The Americans’ Changing Lives (ACL) study was supported by Grant no. AG018418 from the National Institute on Aging (DHHS/NIH), and per the NIH Public Access Policy requires that peer-reviewed research publications generated with NIH support are made available to the public through PubMed Central. NIH is not responsible for the data collection or analyses represented in this article. The ACL study was conducted by the Institute of Social Research, University of Michigan. Dr. Leggett and Dr. Pepin were supported by a National Institute of Mental Health T32 MH073553 postdoctoral fellowship. Shervin Assari is supported by the Heinz C. Prechter Bipolar Research Fund and the Richard Tam Foundation at the University of Michigan Comprehensive Depression Center.

Compliance with Ethical Standards

Authors’ Contribution

The study was designed and drafted by Assari. Data analysis was conducted by Assari. Sonnega, Leggett, and Pepin contributed to the draft and revision. All authors approved the last version.

Conflict of Interest

The authors declare that they have no competing interests.

Informed Consent

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

Animal Studies

No animal studies were carried out by the authors for this article.


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Copyright information

© W. Montague Cobb-NMA Health Institute 2016

Authors and Affiliations

  • Shervin Assari
    • 1
    • 2
  • Amanda Sonnega
    • 3
  • Renee Pepin
    • 4
  • Amanda Leggett
    • 1
  1. 1.Department of PsychiatryUniversity of MichiganAnn ArborUSA
  2. 2.Center for Research on Ethnicity, Culture and Health, School of Public HealthUniversity of MichiganAnn ArborUSA
  3. 3.Institute for Social ResearchUniversity of MichiganAnn ArborUSA
  4. 4.Dartmouth Centers for Health and Aging, Geisel School of MedicineDartmouth CollegeLebanonUSA

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