1083 Sleep Health as a Buffer Between Food Insecurity and Depression in U.S. Adults: NHANES 2017–March 2020

Abstract Introduction Food insecurity and poor sleep are individually linked with depression, but their joint relationship within the US adult population is not fully characterized. This study investigated whether having multifaceted sleep health impacts the relationship between household food insecurity and symptoms of depression. Methods Participants were adults, aged 20 years or older, participating in the National Health and Nutrition Examination Survey from 2017 to March 2020 (analysis: n=5,692; weighted N ≈174,194,776). Food insecurity within households was classified as secure, versus low/very low. Sleep health was defined with a sleep pattern score, rated 0 to 3, accounting for short or long sleep, trouble sleeping, and frequent daytime sleepiness, categorized as healthy, intermediate, or poor. Depressive symptoms were PHQ-9 scores ≥10. Survey-weighted logistic regression with cluster-robust standard errors estimated odds ratios (ORs) and 95% confidence intervals (CIs) for depression by food insecurity, sleep pattern, and their interaction, adjusting for sociodemographic variables. Additive interaction between poor sleep and food insecurity was assessed using the relative excess risk due to interaction (RERI) and attributable proportion (AP). Results Weighted prevalences were 17.2% for low/very low food security, 6.3% for poor sleep pattern, and 9.2% for PHQ-9 ≥10. Food insecurity was significantly associated with increased odds of depression (OR=2.24, 95% CI=1.48–3.39). Compared with healthy sleepers, intermediate and poor sleepers had much higher odds (OR=3.88, 95% CI=2.61–5.79, and OR=19.62, 95% CI=18.71–20.57, respectively). Food insecurity interacted significantly with sleep patterns (joint p < 0.001); ORs for food insecurity compared with security were 2.21, 2.42, and 1.62 for healthy, intermediate, and poor sleepers, respectively. Additive measures of interaction suggested supra-additive interaction effects (RERI=3.08, 95% CI=−6.66–12.83, AP=0.24, 95% CI=−0.49–0.98). However, all CI’s were compatible with zero. Adjustment for sleep pattern reduced the OR of interest from 2.45 to 2.24 (15% attenuation). Conclusion Food insecurity as well as sleep health issues both contribute to depression risk in U.S. adults. The correlation between food insecurity and depression varied across sleep patterns and was strongest in adults with intermediate sleep health and those with lower income. Multidimensional sleep health may offer a modifiable solution, together with structural solutions for addressing food insecurity, for mitigating depression. Support (if any)