# Assessment of Depression and Its Association With Sleep Quality Among the General Population of Perambalur in Tamil Nadu, India: A Cross-Sectional Analysis

## TL;DR

This study in Perambalur, India, finds that depression and poor sleep quality are strongly linked, with severe depression worsening sleep and self-medication being a major risk factor.

## Contribution

The study provides novel insights into the bidirectional relationship between depression severity and sleep quality in a general population of a developing region.

## Key findings

- Moderately severe/severe depression and self-medication strongly predict poor sleep quality.
- PSQI scores increase progressively with depression severity, showing a strong positive correlation (r=0.65).
- 21.8% of participants reported poor sleep quality, with 59.2% having minimal depression.

## Abstract

Background

Sleep quality and depression represent significant public health concerns with complex bidirectional relationships. Despite extensive research in specific populations, comprehensive studies examining their association with general populations remain limited, particularly in developing regions. This study aimed to assess the prevalence of depression and poor sleep quality among the general population of Perambalur, Tamil Nadu, examine their interrelationship, and identify associated sociodemographic and behavioral factors influencing this relationship. Additionally, the study sought to analyze the impact of depression severity on sleep quality parameters and investigate potential risk factors affecting both conditions.

Methodology

A cross-sectional analytical study was conducted among 650 participants from Perambalur district, Tamil Nadu, India. Data collection involved face-to-face interviews using a structured questionnaire comprising sociodemographic profiles, the Pittsburgh Sleep Quality Index (PSQI) for sleep quality assessment, and the Patient Health Questionnaire-9 (PHQ-9) for depression evaluation. The questionnaire underwent forward-backward translation and pilot testing. Sleep quality was categorized using PSQI scores (>5 indicating poor sleep), while depression severity was classified as minimal (0-4), mild (5-9), moderate (10-14), moderately severe (15-19), and severe (20-27). Data analysis employed descriptive statistics, chi-square tests, and multivariable logistic regression, with p<0.05 considered statistically significant.

Results

The study population, with a mean age of 35.71±14.70 years, comprised 381 (58.6%) females and 269 (41.4%) males. The depression analysis revealed that 385 (59.2%) participants had minimal depression, 171 (26.3%) had mild depression, 62 (9.5%) had moderate depression, 27 (4.2%) had moderately severe depression, and five (0.8%) had severe depression. Poor sleep quality was reported by 142 (21.8%) participants. Sleep-related parameters showed 100 (15.4%) participants experiencing difficulty initiating sleep, 102 (15.7%) reporting midnight awakenings, and 34 (5.2%) using self-medication. Logistic regression identified self-medication (adjusted odds ratio (AOR)=8.45, 95% CI: 3.12-22.86) and moderately severe/severe depression (AOR=7.92, 95% CI: 3.45-18.19) as the strongest predictors of poor sleep quality. PSQI scores demonstrated progressive deterioration across depression severity levels, increasing from 3.2±1.8 in minimal to 11.3±3.2 in severe depression. A strong positive correlation was observed between PSQI and PHQ-9 scores (r=0.65, p<0.001).

Conclusion

The study establishes significant associations between depression severity and sleep quality, highlighting the need for integrated healthcare approaches. The identified sociodemographic risk factors and high prevalence of self-medication underscore the importance of targeted interventions and improved access to professional healthcare services, particularly focusing on vulnerable populations in both urban and rural settings.