Depression Scores Associate With Chronotype and Social Jetlag in a Rural Population

Abstract

In public health, mood disorders are among the most important mental impairments. Patients with depressive episodes exhibit daily mood variations, abnormal patterns in sleep-wake behavior, and in the daily rhythms of several endocrine-metabolic parameters. Although the relationship between the sleep/circadian processes and mood disorders is poorly understood, clock-related therapies, such as light therapy, sleep deprivation, and rigid sleep schedules, have been shown to be effective treatments. Several studies investigated the relationship between circadian phenotype (chronotype) and depression. These focused mainly on urban populations and assessed diurnal preferences (Morningness-Eveningness score) rather than the actual timing of sleep and activity. Here, we used the Beck Depression Inventory (BDI) in an essentially rural population (N = 4051), and investigated its relation to circadian phenotype (chronotype and social jetlag), assessed with the Munich Chronotype Questionnaire (MCTQ). In our study design, we (i) normalized both chronotype and BDI scores for age and sex (MSF_sas and BDI_as, respectively); (ii) calculated individual social jetlag (misalignment of the biological and social time); and (iii) investigated the relationship between circadian phenotypes and BDI scores in a population homogeneous in respect to culture, socioeconomic factors, and daily light exposure. A 15.65% (N = 634) of the participants showed mild to severe depressive BDI scores. Late chronotypes had a higher BDI_as than intermediate and early types, which was independent of whether or not the participants were smokers. Both chronotype and BDI_as correlated positively with social jetlag. BDI_as was significantly higher in subjects with >2 h of social jetlag than in the rest of the population—again independent of smoking status. We also compared chronotype and social jetlag distributions between BDI categories (no symptoms, minimal symptoms, and mild to severe symptoms of depression) separately for men and women and for four age groups; specifically in the age group 31–40 yrs, subjects with mild to severe BDI scores were significantly later chronotypes and suffered from higher social jetlag. Our results indicate that misalignment of circadian and social time may be a risk factor for developing depression, especially in 31- to 40-yr-olds. These relationships should be further investigated in longitudinal studies to reveal if reduction of social jetlag should be part of prevention strategies. (Author correspondence: [email protected])

Keywords:

• Chronotype
• Circadian clock
• Depression
• Mood disorders
• Sleep-wake behavior
• Social jetlag

ACKNOWLEDGMENTS

We thank the graduate students Alicia Deitos, Ana Claudia Souza, Fabiane Dresch, Gabriela Laste, and Janaina da Silveira (Univates) and Andre Oliveira Marques, Cristiane Koplin, Diego Fraga, Fabiana Guarienti, Jane Cronst, and Manoela Jornada (UFRGS) for their assistance in data collection and data management. We thank Prof. Hans Distel (LMU) for the fruitful discussions that contributed to improve this manuscript. This work was supported by PROBRAL/CAPES/Brazil, PNPD/CAPES/Brazil, FIPE/HCPA/Brazil, Propesq/UFRGS (M.P.H., R.M.L., and G.D.), Univates (undergraduate scholarships), DAAD/PROBRAL, Die Frauenbeauftragte der LMU and EUCLOCK (K.A., T.R.).

Declaration of Interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.