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. 2023 Apr 28;10(8):5446–5452. doi: 10.1002/nop2.1783

Sleep‐related problems as a mediator in the association between depression and work–family conflict in middle‐aged female workers: A population‐based study

Yoonjeong Lee 1, Mikyung Ryu 2,✉
PMCID: PMC10333866  PMID: 37114859

Abstract

Aim

To investigate the mediating effect of sleep‐related problems on the relationship between depression and work–family conflicts (WFCs) among middle‐aged female workers.

Design

Secondary analysis of cross‐sectional study.

Methods

Overall, 15,718 female workers aged 40–65 years from the Sixth Korean Working Conditions Survey (KWCS) were included. Depression was assessed using the WHO‐5 wellbeing index; sleep‐related problems and WFCs were measured with five items on a Likert scale. The mediating effect of sleep‐related problems between depression and WFCs was analysed using model 4 of Hayes PROCESS macro for SPSS.

Results

There was a significant positive correlation between depression and both sleep‐related problems (r = 0.225, p < 0.001) and WFCs (r = 0.124, p < 0.001). Depression also had a significant effect on sleep‐related problems (β = 0.221, p < 0.001) and WFCs (β=0.061, p < 0.001). Sleep‐related problems had a significant effect on WFCs (β = 0.282, p < 0.001). The indirect effect of depression on WFCs by mediating sleep‐related problems was β = 0.062 (95% bootstrap confidence interval = 0.057–0.068). The study also confirmed the significance of the mediating effect of sleep‐related problems in the relationship between depression and WFCs.

Keywords: depression, professional‐family relations, sleep disorders

1. INTRODUCTION

1.1. Background

According to the Statistics on Women's Lives, 2017 in Korea, the female employment rate in Korea was 50.2%, exceeding 50% for the first time (MOGEF, 2017). The employment rate of women continues to rise as more women participate in economic activities.

However, the proportion of irregular workers among middle‐aged Korean females aged in their 40s and 50s is high at 21.4%–22.4%, which indicates their high level of job instability (MOGEF, 2017).

A woman's middle age, an intermediate stage between maturity and old age, is a period that involves adaptation to various psychological and social changes including physical changes, family roles, social support structures, and loss of interpersonal relationships due to endocrine system imbalance and aging (Chang, 2018; Kim & Kim, 2013). Psychological instability in this period has been shown to be related to the family‐oriented attitude of middle‐aged females, and the job satisfaction of working females over the age of 45 years influences their quality of life (Kim & Hong, 2009).

Middle‐aged females between the ages of 40 and 65 years may have health problems such as sleep disturbance and depression due to physical, mental and social changes associated with menopause (Kim & Kim, 2009; Lee et al., 2019; Morssinkhof et al., 2020). Sleep problems affect not only the quality of the worker's own daily life but also their workplace. In individuals with sleep disorders, mental or physical disabilities occur due to related diseases caused by a lack of sleep, and ‘invisible damage’ occurs due to a decrease in work efficiency and errors (Lockley et al., 2007).

In addition, middle‐aged females often experience depression due to changes in roles and psychosocial work environment changes as they age (Lee & Choi, 2007), and they tend to experience more depressive symptoms than men of the same age range (Jeon, 2012; Lee et al., 2016). Studies have confirmed that depression lowers the overall job performance of workers, including a decrease in productivity (Hori & Kamo, 2014). Depression is associated with work–family conflict (Hwang & Yu, 2021; Zhang et al., 2017), and a study by Hwang and Yu (2021) showed that depression affects work–family conflict.

Work–family conflict (WFC) is a type of role conflict that occurs when work and family roles are incompatible, affecting decision‐making related to individuals and organizations (Byron, 2005). Recently, there has been a continual increase in the economically active female population in Korea. Although it remains difficult to separate a female's work and family roles, their economic activity and practical participation have increased, and yet societal expectations remain that females are primarily responsible for childcare and housework. If the conflict between work and family roles persists, a female's physical and mental health can deteriorate (Kang & Jang, 2020), the quality of life of individuals and families (Greenhaus et al., 2003), job satisfaction, and organizational commitment can all decrease, and turnover can increase (Greenhaus et al., 2003; Greenhaus & Powell, 2006).

Although previous studies have evaluated the effects of WFCs on general workers (du Prel & Peter, 2015) and special occupational groups with high work stress such as nurses and truck drivers (Ding et al., 2020; Mohamed et al., 2022; Shin & Jeong, 2020; Zhang et al., 2017), the relationship between WFCs and sleep problems and depressive symptoms is poorly understood. Few studies have investigated the effect of health behaviours such as sleep on the association between WFCs and depressive symptoms in middle‐aged female general workers. Therefore, this study aimed to investigate the relationship between WFCs, depression, and sleep‐related problems among middle‐aged female workers in South Korea. This should help improve our understanding of the variables affecting WFCs in middle‐aged females, improve the quality of their sleep, and improve their work environment to maintain a healthy work‐family balance. It should also help improve the management of depression in middle‐aged female workers.

1.2. Research question

The aim of this study was to elucidate the relationship between sleep‐related problems, depression, and WFC. It is hypothesized that sleep‐related problems are mediated between depression and WFC in middle‐aged female workers. To evaluate the hypothesis that sleep‐related problems may mediate the relationship between depression and WFC, we performed a moderator model that combined previous studies.

2. METHODS

2.1. Design and sample

This study was cross‐sectional and employed a secondary data analysis based on the 2020 6th Korean Working Conditions Survey (KWCS) of the Occupational Safety and Health Research Institute, as a representative sample of the Korean working population (OSHRI, 2020). The KWCS is a survey benchmarking the European Working Conditions Survey (EWCS) conducted by Eurofound (2015) under the European Union, and is a nationally approved statistic (approval number 38002). The validity and reliability of KWCS were confirmed in the study of Kim et al. (2013), including evaluation of the questionnaire development process, which entailed translation and reverse translation of the questions in the EWCS. The 6th KWCS used in this study was conducted from October 2020 to April 2021 as one‐on‐one individual interviews with household visits by professional surveyors. The subjects of the data analysis in this study were 15,718 middle‐aged female workers between the ages of 40 and 65 years.

2.2. Measures

2.2.1. General characteristics

The general characteristics of the study subjects evaluated comprised of demographic, work‐related and health‐related characteristics. The demographic and sociological characteristics consisted of age, education level, residential area, whether they were living with family members and household financial status. The work‐related characteristics consisted of occupation, employment type, working hours per week, work duration, and satisfaction with the working environment. Health‐related characteristics consisted of subjective health status.

2.2.2. Depression

Depression was evaluated using a five‐item questionnaire about feelings experienced by the respondent in the past 2 weeks. The five items were: I have felt cheerful and in good spirits, I have felt calm and relaxed, I have felt active and vigorous, I woke up feeling fresh and rested, and My daily life has been filled with things that interest me. Each question was scored on a 5‐point scale summed to a total score ranging from 0 to 25. The questionnaire was developed as a well‐being index of the WHO (1998) and used as a depression scale by inverse scoring. As a result of a systematic literature review, it was verified that the validity as a screening tool for depression was high (Topp et al., 2015). A higher score indicates a higher level of depression (WHO, 1998). The reliability of these items was Cronbach's ⍺ 0.799–0.804 in the previous study (Kim, 2022) and 0.907 in this study.

2.2.3. Sleep‐related problems

Sleep‐related problems were measured by the Q63 questions of the 2020 KWCS questionnaire (which are the same as the Q79 questions of the 2015 EWCS questionnaire; Eurofound, 2015), with three items: difficulty falling asleep, waking up repeatedly during sleep, waking up with a feeling of exhaustion and fatigue for 12 months. Each item was measured on a five‐point scale. A higher score indicates more sleep problems, and in the reliability assessment, Cronbach's alpha was 0.821 in the previous study (Shin & Jeong, 2020) and 0.873 in this study.

2.2.4. Work–family conflict

Work–family conflict (WFC) was measured using the five Q38 questions of the 2020 KWCS questionnaire (which were the same as the Q45 questions of the 2015 EWCS questionnaire; Eurofound, 2015): kept worrying about work when you were not working, felt too tired after work to do some of the housework jobs which need to be done, found that your job prevented you from giving the time you wanted to your family, found it difficult to concentrate on your job because of your family responsibilities, and found that your family responsibilities prevented you from giving the time you should to your job. Each item was measured on a five‐point scale. The higher the score, the higher the WFCs, and in the previous study Cronbach's alpha for these items was 0.813 (Shin & Jeong, 2020), and in this study was 0.849.

2.3. Analytic strategy

The data were analysed using the SPSS/WIN 25.0 statistical program and the PROCESS macro for SPSS V.4.1. General characteristics and the level of variables were analysed using descriptive statistics. For correlation analysis between depression, sleep problems and WFCs, Pearson correlation coefficients were used. The mediating effect of sleep‐related problems between depression and WFCs was analysed with model 4 of the Hayes PROCESS macro for SPSS V.4.1 (Hayes, 2018). To confirm the significance of the mediating effect of the sleep related problem, 10,000 bootstraps were performed and a 95% confidence interval (CI) was measured.

2.4. Ethics

All participants provided written informed consent at the time of data collection for the use of their information in future studies, including secondary data analysis. This study was approved by the Institutional Review Board Committee to which the author belongs (IRB NO. 2020‐035‐08).

3. RESULTS

3.1. General characteristics of participants

The socio‐demographic and work‐related characteristics of the study participants are presented in Table 1. There were 15,718 middle‐aged females included in this study, and their average age was 52.3 (±6.75) years. In terms of level of education, 90% graduated from high school or above, and 85.6% lived with their families. Occupations included service workers (25.5%), sales workers (20.7%), professionals (16.4%) and clerks (15%). Employment types reported by participants included regular employees (49.1%), self‐employed (32.4%) and temporary employees (10.3%). In terms of working hours, 57.7% worked 37–52 h a week and 18.7% worked more than 53 h. Regarding health status, 96% had a subjective health status of fair or higher.

TABLE 1.

Socio‐demographic and work‐related characteristics of the participants (n = 15,718).

Characteristics Categories n (%) or M ± SD
Age (years) 40–49 5661 (36.0)
50–59 7286 (46.4)
60–<65 2771 (17.6)
52.3 ± 6.75
Education (n = 15,693) Middle school or less 1575 (10.0)
High school 7802 (49.8)
College or higher 6316 (40.2)
Residence area Metropolitan area 7015 (44.6)
Non‐metropolitan area 8703 (55.4)
Residence with family Yes 13,451 (85.6)
No 2267 (14.4)
Occupation Legislators, senior officials, and managers 34 (0.2)
Professionals, technicians, and associate professionals 2571 (16.4)
Clerks 2366 (15.0)
Service workers 4001 (25.5)
Sales workers 3258 (20.7)
Skilled agricultural, forestry, and fishery workers 646 (4.1)
Craft & related trades Workers 665 (4.2)
Plant & machine operators, and assemblers 687 (4.4)
Simple workers 1490 (9.5)
Employment Self‐employed 5106 (32.4)
Regular employee 7721 (49.1)
Temporary employee 1624 (10.3)
Daily employed 430 (2.7)
Others 837 (5.3)
Weekly working hours (n = 15,632) ≤18 1033 (6.6)
19–36 2654 (17.0)
37–52 9020 (57.7)
≥53 2925 (18.7)
Working duration (years) (n = 15,512) <5 6589 (42.4)
5–9 3671 (23.7)
≥10 5252 (33.9)
Income (n = 15,627) Insufficient 4747 (30.4)
Just sufficient 10,880 (69.6)
Work environment satisfaction (n = 15,656) Not satisfied 2497 (15.9)
Satisfied 13,159 (84.1)
Subjective health status (n = 15,689) Very bad 27 (0.2)
Bad 602 (3.8)
Fair 4818 (30.8)
Good 9374 (59.7)
Very good 868 (5.5)
3.7 ± 0.65
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Abbreviations: M, mean; SD, standard deviation.

3.2. Relationship between depression, sleep‐related problems and work–family conflict

Table 2 shows the correlations between depression, sleep‐related problems, and WFCs. There was a significant positive correlation between depression and sleep‐related problems (r = 0.225, p < 0.001), and between depression and WFCs (r = 0.124, p < 0.001). Sleep‐related problems and WFCs were also significantly positively correlated (r = 0.296, p < 0.001).

TABLE 2.

Descriptive statistics and correlation among study variables.

Variables M ± SD Range Depression Sleep‐related problems Work–family conflicts
r (p) r (p) r (p)
Depression 10.72 ± 5.06 0–25 1
Sleep‐related problems 1.76 ± 0.78 1–5 0.225 (<0.001) 1
Work–family conflicts 1.98 ± 0.73 1–5 0.124 (<0.001) 0.296 (<0.001) 1
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Abbreviations: M, mean; SD, standard deviation.

3.3. The mediating effect of sleep‐related problems in depression and work–family conflict

As a result of confirming multicollinearity between study variables before testing the mediating effect of sleep‐related problems on the relationship between depression and WFCs, the tolerance was 0.951, which was more than 0.1, and the variance inflation factor (VIF) value was 1.051, less than 10, so there was no issue with multicollinearity in the data. The Durbin–Watson index was 1.962, close to 2.00, and there was therefore no issue with autocorrelation of the residuals. Figure 1 shows the results of examining the mediating effect of sleep‐related problems on the relationship between depression and WFCs in middle‐aged female workers.

FIGURE 1.

FIGURE 1

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Results of the mediator model in this study.

Depression was found to have a significant effect on sleep‐related problems (β = 0.221, p < 0.001) and WFCs (β = 0.061, p < 0.001). Sleep‐related problems were also found to have a significant effect on WFCs (β = 0.282, p < 0.001; Table 3).

TABLE 3.

Mediating effect of sleep‐related problems in the relationship between depression and work–family conflicts.

Pathway Standardized β S.E. t (p) 95% CI
Lower Upper
Depression → Sleep‐related problems 0.221 0.001 27.728 (<0.001) 0.032 0.036
Depression → Work–family conflicts 0.061 0.001 7.656 (<0.001) 0.007 0.011
Sleep‐related problems → Work–family conflicts 0.282 0.008 35.327 (<0.001) 0.251 0.281
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Abbreviations: CI, confidence interval; SE, standard error.

To verify the significance of the indirect effect, the data were extracted 10,000 times and a bootstrap was performed. As a result of this analysis, the magnitude of the indirect effect of depression on WFCs by mediating sleep‐related problems was statistically significant (β = 0.062, 95% bootstrap CI = 0.057–0.068; Table 4).

TABLE 4.

Bootstrapping outcome of indirect effect on work–family conflicts.

Pathway Indirect effect S.E. 95% CI
Lower Upper
Depression → Sleep‐related problems → Work–family conflicts 0.062 0.003 0.057 0.068
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Abbreviations: CI, confidence interval; S.E., standard error.

4. DISCUSSION

In this study, there was a significant association between the variables of depression, sleep‐related problems, and WFCs among middle‐aged females. Depression was found to have a significant effect on sleep‐related problems (β = 0.221, p < 0.001) and WFCs (β = 0.061, p < 0.001). Sleep‐related problems were found to have a significant impact on WFCs (β = 0.282, p < 0.001). Depression in females in middle age may be a contributing factor due to various losses and subsequent changes, as follows: negative attitudes towards aging and menopause; loss of health due to illness or disability; loss of the social support system due to children's independence; transition of relationships in life (separation, divorce, death of parents), experience of the loss of social status due to job loss, retirement, and other reasons (Dennerstein et al., 2004; Lee et al., 2016).

Furthermore, middle‐aged females are at high risk of sleep‐related problems due to physical and psychological changes as they go through menopause (Kim & Kim, 2009; Lee et al., 2019; Morssinkhof et al., 2020). In females between the ages of 40 and 65 years, when estrogen secretion decreases, menopause does not occur temporarily at one specific time; instead, over a considerable period of time, hormones fluctuate and the menstrual cycle becomes irregular along with various physical and psychological changes, occurring through a transitional period (Lobo et al., 2000). Middle‐aged females in this period often experience sleep‐related problems due to physiological changes (Lee et al., 2019; Morssinkhof et al., 2020), and these sleep‐related problems have been shown to be related to depression in several studies (Lee et al., 2022; Morssinkhof et al., 2020; Terauchi et al., 2012).

In this study, we found that sleep‐related problems had a statistically significant effect as a mediator in the relationship between WFCs and depression among middle‐aged females (indirect effect = 0.062, 95% bootstrap CI = 0.057–0.068). Previous studies have reported that WFC is associated with emotional fatigue and depressive symptoms. Sleep disturbance due to excessive workload has been shown to be associated with a higher risk of depression due to work stress and burnout due to work (Hwang & Yu, 2021; Zhang et al., 2017). According to a study by Lallukka et al. (2010), WFCs were also strongly associated with sleep in middle‐aged females (odds ratio = 5.90; 95% CI = 4.16–8.38). A study by Zhang et al. (2017) reported a significant association (β = 2.22, p < 0.001) between WFCs and depressive symptoms among nurses, and sleep disturbance partially mediated this association. WFC has also been significantly associated with sleep quality and depressive symptoms among nurses in two studies (Mohamed et al., 2022; Zhang et al., 2017). A study on female nurses in China showed a strong positive correlation between sleep disturbance and depressive symptoms (Ding et al., 2020). In a cohort study of workers in Germany, WFC was also significantly associated with workplace stress and depressive symptoms (du Prel & Peter, 2015), and a study of truck drivers experiencing high‐intensity and high‐stress work found that sleep‐related problems were more affected by WFC levels than negative work situation levels (Shin & Jeong, 2020).

The above previous studies on the relationship between depression, sleep problems, and WFCs have frequently been conducted on nurses with high work stress or irregular working hours (Ding et al., 2020; Hwang & Yu, 2021; Mohamed et al., 2022; Zhang et al., 2017; Zurlo et al., 2020). The occupations of the middle‐aged females in this study largely included clerks, sales, and service workers, and it may therefore be difficult to directly compare depression and sleep disorders caused by work stress associated with special tasks observed in the previous studies. However, in this study, we found that WFCs were positively associated with sleep‐related problems and depressive symptoms among middle‐aged female workers, which is consistent with previous findings in high‐risk populations and other occupational groups (Ding et al., 2020; du Prel & Peter, 2015; Hwang & Yu, 2021; Shin & Jeong, 2020; Zhang et al., 2017).

The highlight of our study is that we were able to identify sleep problems as a mediator in the relationship between WFCs and depression in middle‐aged females using data representing the Korean working environment. The Korean female labour force participation rate is closely related to a female's life cycle. In their 20s and 30s, the proportion of females who stopped economic activities due to childcare was high, but the labour force participation rate of females aged 45–60 years, when their children have grown up and become independent, continues to increase (Lee, 2013). During this period, middle‐aged female workers are at high risk of WFCs due to sleep‐related problems and psychosocial stressors associated with physical and psychosocial changes (Kim & Hong, 2009; Kim & Kim, 2009; Lee et al., 1996). This study suggests that sleep‐related problems, appearing in the middle age of a female's life cycle, may function as a mediator for depression and work–family problems. It is expected that the development of interventions for sleep‐related problems will be helpful in reducing WFCs among middle‐aged Korean females.

4.1. Limitations

Although our study was comprised of a group of middle‐aged females with homogeneous age, sex, and occupations, it is limited by the fact that the KWCS data in Korea does not contain data on medical diseases related to the diagnosis of depression or sleep disorders; therefore, these issues could not be controlled. Nevertheless, our findings suggest that preventing sleep‐related problems may help reduce stress and absenteeism associated with depression and WFCs among middle‐aged females.

5. CONCLUSION

In conclusion, the results of this study indicate that as depression increases among middle‐aged females, sleep‐related problems and WFCs increase. As sleep problems increase, WFCs also increase. We have also confirmed the mediating effect of sleep‐related problems on the relationship between depression and WFCs. It suggests that interventions to address sleep‐related problems may reduce depression among middle‐aged female workers and reduce WFCs.

AUTHOR CONTRIBUTIONS

All authors have agreed on the final version and meet at least one of the following criteria [recommended by the ICMJE (http://www.icmje.org/recommendations/)]: substantial contributions to conception and design, acquisition of data or analysis and interpretation of data; drafting the article or revising it critically for important intellectual content.

FUNDING INFORMATION

This research was supported by a fund (2020‐0247) from Daegu University.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interest.

ETHICS STATEMENT

This study was approved by Daegu University research ethics committee, Korea (IRB NO. 2020‐035‐08).

ACKNOWLEDGEMENTS

The authors thank the Safety and Health Policy Research Department (Occupational Safety and Health Research Institute) for providing the raw data of the KWCS (Korean Working Conditions Survey). The paper's contents are solely the responsibility of the authors and do not necessarily represent the official views of the Occupational Safety and Health Research Institute.

Lee, Y. , & Ryu, M. (2023). Sleep‐related problems as a mediator in the association between depression and work–family conflict in middle‐aged female workers: A population‐based study. Nursing Open, 10, 5446–5452. 10.1002/nop2.1783

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available in OSHRI at https://oshri.kosha.or.kr/eoshri/index.do. These data were derived from the following resources available in the public domain: The 6th KWCS, https://oshri.kosha.or.kr/eoshri/resources/KWCSDownload.do.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available in OSHRI at https://oshri.kosha.or.kr/eoshri/index.do. These data were derived from the following resources available in the public domain: The 6th KWCS, https://oshri.kosha.or.kr/eoshri/resources/KWCSDownload.do.

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