Chronotypes in patients with nonseasonal depressive disorder: Distribution, stability and association with clinical variables

Abstract

The individual's chronotype is regarded as rather stable trait with substantial heritability and normal distribution of the "morningness-eveningness" dimension in the general population. Eveningness has been related to the risk of developing affective, particularly depressive, disorders. However, age and other sociobiological factors may influence chronotypes. The present study investigated the distribution, stability, and clinical correlates of chronotype and morningness-eveningness in hospitalized patients with affective disorder. Chronotype was assessed with the morningness-eveningness questionnaire (MEQ) in 93 patients with nonseasonal depressive syndrome (85% major depression; 15% depressive adjustment disorder) after admission, and in 19 patients again before discharge. Distribution, stability and correlations of MEQ scores with clinical variables were calculated. Additionally, a literature analysis of chronotype distributions in samples of nondepressed persons and patients with nonseasonal depression was carried out. MEQ scores (mean 49 ± 11, range 23-75, higher scores indicate morningness) in 93 acutely depressed inpatients (age 41 ± 14 years, range 18-75 years; 63% women; hospitalization 48 ± 22 days; BDI-II 32 ± 11) were normally distributed (Shapiro-Wilk test; W = 0.993, p = 0.920) with 59.1% intermediate types, 19.4% evening types, and 21.5% morning types. MEQ change scores from admission to discharge were nonsignificant (-1.3 ± 5.0; paired t-test, t18 = -1.09; p = 0.29) despite significantly improved depression scores (-19.4 ± 7.6; paired t-test, t18 = 11.2, p < 0.001). Age (r = 0.24), and depression scores (r = -0.21) correlated significantly (p < 0.05) with MEQ scores; associations with sex and hospitalization duration were nonsignificant. The present study and literature findings revealed that the frequency of evening types is not clearly elevated in depression, but morning types are less frequent compared to healthy samples (p < 0.001). Morningness-eveningness scores were normally distributed and stable in depressive inpatients. In line with previous findings, but contrary to theoretical assumptions, evening types were not overrepresented in depressed patients. Additionally, relatively less morning types and more intermediate types were found in depressed patients. Future studies should focus on transitions from morning to intermediate types as a tentative risk or correlate of emerging depression.

Stability of chronotype over a 7‐year follow‐up period and its association with severity of depressive and anxiety symptoms

“…Moreover, the long‐term stability of chronotype and its association to fluctuations in severity of depressive and anxiety symptoms is largely unexplored. To the best of our knowledge, only one study addressed this question (Müller et al, 2015). They found that the preference for sleep timing in depressive patients, as assessed with the MEQ, was highly correlated ( r = 0.82, p < .001) over the course of a hospitalization period (mean stay: 48.6 days), despite a significant improvement in patient's depressive symptoms.…”

Chronotype in bipolar disorder: an 18-month prospective study

“…2 Evening chronotype is often associated with mood disorders. 3,4 A large cohort study showed that depressive and anxiety disorders are associated with late circadian preference, even adjusting for sociodemographic and sleep-related factors. 5 Eveningness is more common in adult BD patients.…”

Genetic Influences on Evening Preference Overlap with Those for Bipolar Disorder in a Sample of Mexican Americans and American Indians

“…Lifespan decreases as the magnitude of circadian period length deviation from the 24-hour cycle increases in rodents, and primate species (Kerkhof, 1985; Partonen, 2013; Wyse et al, 2010). Evening preference is associated with several psychosocial and psychopathological issues (Fabbian et al, 2016; Fares et al, 2015; Haregu et al, 2015; Merikanto et al, 2016; Rose et al, 2015; Voinescu et al, 2012), including depression (Abe et al, 2011; Antypa et al, 2016; Chan et al, 2014; Chelminski et al, 1999; Drennan et al, 1991; Gaspar-Barba et al, 2009; Hidalgo et al, 2009; Kitamura et al, 2010; Levandovski et al, 2011; Merikanto et al, 2015; Merikanto et al, 2013; Muller et al, 2015; Reid et al, 2012), bipolar disorder (Ahn et al, 2008; Giglio et al, 2010; Jeong Jeong et al, 2015; Mansour et al, 2005; Melo et al, 2016; Seleem et al, 2015; Wood et al, 2009), and substance use (Adan, 1994; Barclay et al, 2013; Broms et al, 2011; Hasler et al, 2013; Kervran et al, 2015; Lemoine et al, 2013; Reid et al, 2012; Sivertsen et al, 2015). …”

“…In the second analysis, polygenic risk score profiling was used to determine whether a larger proportion of variance in diurnal preference could be attributed to variants that have been associated with other complex disorders. The following phenotypes were analyzed for overlapping genetic influences with chronotype: bipolar disorder and depression, given the robust link between these psychiatric disorders and chronotype (Abe et al, 2011; Ahn et al, 2008; Antypa et al, 2016; Chan et al, 2014; Chelminski et al, 1999; Drennan et al, 1991; Gaspar-Barba et al, 2009; Giglio et al, 2010; Hidalgo et al, 2009; Jeong Jeong et al, 2015; Kitamura et al, 2010; Levandovski et al, 2011; Mansour et al, 2005; Melo et al, 2016; Merikanto et al, 2015; Merikanto et al, 2013; Muller et al, 2015; Reid et al, 2012; Seleem et al, 2015; Wood et al, 2009); and schizophrenia and body mass index, given previously identified genetic correlations between these phenotypes and chronotype (Lane et al, 2016). …”