Insomnia symptoms mediate the association between eveningness and suicidal ideation, defeat, entrapment, and psychological distress in students

Abstract

Chronotype describes a person's general preference for mornings, evenings, or neither. It is typically conceptualized as a continuous unidimensional spectrum from morningness to eveningness. Eveningness is associated with poorer outcomes across a myriad of physical and mental health outcomes. This preference for later sleep and wake times is associated with increased risk of depression, anxiety, and suicidal ideation in both clinical and community samples. However, the mechanisms underlying the negative consequences of this preference for evenings are not fully understood. Previous research has found that sleep disturbances may act as a mediator of this relationship. The present study aimed to explore the associations between chronotype and affective outcomes in a sample of students. Additionally, it aimed to investigate the potential role of insomnia as a mediator within these relationships. Participants (n = 190) completed an anonymous self-report survey of validated measures online which assessed chronotype, insomnia symptoms, and a range of affective outcomes (defeat, entrapment, suicide risk, stress, and depressive and anxious symptomology). Eveningness was associated with more severe or frequent experiences of these outcomes, with participants that demonstrated a preference for eveningness more likely to report poorer affective functioning and increased psychological distress. Mediation analysis found the relationship between chronotype and these outcome measures was completely or partially mediated by insomnia symptom severity measured by the validated Sleep Condition Indicator insomnia scale. Taken together, these findings add further evidence for the negative consequences of increased eveningness. Additionally, our results show that chronotype and sleep disturbances should be considered when assessing mental well-being. Implementing appropriate sleep-related behavior change or schedule alterations can offer a tool for mitigation or prevention of psychological distress in students that report a preference for later sleep and wake times.

RETRACTED ARTICLE: Factors associated with insomnia among frontline nurses during COVID-19: a cross-sectional survey study

“…The study’s findings extend prior findings that neuroticism strongly predicts lower subjective sleep quality [ 48 ]. Additionally, individuals high in neuroticism exhibit lower sleep quality and frequently report unwanted wakefulness after sleep onset [ 49 ]. Vulnerability to psychological disorders is key to understanding differential stress responses to severe life events.…”

Chronotype, circadian rhythm, and psychiatric disorders: Recent evidence and potential mechanisms

“…A large body of evidence demonstrated that poor sleep quality or sleep disorders mediate the association between evening chronotype and depressive symptoms in healthy subjects and patients with mood disorders ( Van den Berg et al, 2018 ; Caruso et al, 2020 ; Li et al, 2020 ; Tian et al, 2020 ; Uzer and Yucens, 2020b ; Lin et al, 2021 ; Zhou et al, 2021 ) or other adverse outcomes ( Cox and Olatunji, 2019 ; Kandeger et al, 2019 ; Najem et al, 2020 ; Bradford et al, 2021 ). A study of older adults with depression indicated that the relationship between evening chronotype and depression is fully mediated by insomnia severity ( Uzer and Yucens, 2020b ).…”

“…Clinical evaluation of patients with BD indicated that poor sleep quality mediated the association between evening chronotype and residual depressive symptoms ( Caruso et al, 2020 ). A recent study revealed that insomnia partially mediates the effect of chronotype on depression and anxiety, completely mediating the association between chronotype and suicidal ideation ( Bradford et al, 2021 ). The relationship between evening chronotype and psychological distress showed a mediation effect ( Hou et al, 2020 ).…”

The fall of vulnerability to sleep disturbances in evening chronotypes when working from home and its implications for depression

“…All the above outcomes were analyzed as continuous variables. The direction of the effects was established by relying on a consistent meta-analytic literature on longitudinal epidemiological studies supporting a causal role of sleep problems in the development of depressive symptoms 24 , 26 , 27 , as well as on several studies proposing a mediation effect of sleep variables between chronotype and depression 30 – 36 . We separately included sleep variables as mediators in each model due to violations of the assumptions for alternative parallel mediation analysis 44 .…”

“…In this view, it is unsurprising that the evening chronotype has been systematically associated with a mood disturbance propensity 17 , 29 . Indeed, several recent reports suggested a causal role of sleep problems in accounting for the association between eveningness and depression 30 – 36 . On the other hand, people tending to go to bed and wake up earlier (“ larks ”) are less affected by social jetlag , having their sleep–wake rhythms aligned with the common social clock.…”