Clinical correlates of chronotypes in young persons with mental disorders

Abstract

While important changes in circadian rhythms take place during adolescence and young adulthood, it is unclear how circadian profiles during this period relate to emerging mental disorders. This study aimed to: (i) characterise morningness–eveningness preference in young people with primary anxiety, depression, bipolar or psychotic disorders as compared to healthy controls, and (ii) to investigate associations between morningness–eveningness preference and the severity of psychiatric symptoms. Four hundred and ninety-six males and females aged between 12 and 30 years were divided into five groups according to primary diagnosis. The Hamilton Depression Rating Scale and the Brief Psychiatric Rating Scale were administered by a research psychologist and participants completed the Kessler Psychological Distress Scale and the Horne–Östberg Morningness–Eveningness Questionnaire (ME). ME scores were significantly lower (i.e. higher levels of “eveningness”) in all patient diagnosis subgroups compared to the control group. The psychosis group had higher ME scores than the depression and anxiety groups. Compared to the control group, the anxiety, depression and bipolar subgroups had a significantly higher proportion of “moderate evening” types, with a similar trend for the psychosis group. The proportion of “extreme evening” types was significantly higher in the anxiety and depression subgroups than in the control group. Lower ME scores correlated with worse psychological distress in males from the bipolar group. Lower ME scores correlated with higher depression severity in females with depression and in males with bipolar disorder. These results suggest that young persons with various mental disorders, especially those with affective disorders, present with a stronger “eveningness” preference and higher rates of evening chronotypes than healthy controls from the same age group. Later chronotypes were generally associated with worse psychological distress and symptoms severity. These associations were modulated by sex and primary diagnosis.

• Anxiety
• bipolar disorder
• chronotypes
• depression
• morningness–eveningness preference
• psychiatric symptoms
• psychotic disorders

ACKNOWLEDGEMENTS

This study was funded from a National Health and Medical Research Council (NHMRC) Australia Fellowship awarded to I. B. Hickie (No. 464914) and supported by the Sydney University Research Networks. R. Robillard received a postdoctoral training award from the Fonds de la recherche en santé du Québec. D. F. Hermens is currently supported by a grant from the NSW Health, Mental Health and Drug & Alcohol Office. S. L. Naismith is supported by an NHMRC Career Development Award.

DECLARATION OF INTEREST

D. F. Hermens has received honoraria for educational seminars from Janssen-Cilag and Eli Lilly. E. M. Scott is the (unpaid) Clinical Director of Headspace Services at the Brain and Mind Research Institute (BMRI), the (unpaid) Coordinator of the Youth Mental Health Research Program at the BMRI and Deputy Director of St Vincent’s Private Hospital Young Adult Mental Health Unit. She has received honoraria for educational seminars related to the clinical management of depressive disorders supported by Servier and Eli Lilly pharmaceuticals. She has participated in a national advisory board for the antidepressant compound Pristiq, manufactured by Pfizer. I. B. Hickie was a director of Headspace: The National Youth Mental Health Foundation until January 2012. He is the executive director of the BMRI, which operates two early-intervention youth services under contract to Headspace. He is a member of the new Australian National Mental Health commission and was previously the CEO of Beyondblue: The National Depression Initiative. He has led a range of community-based and pharmaceutical industry – supported depression awareness and education and training programs. He has led depression and other mental health research projects that have been supported by a variety of pharmaceutical partners. Current investigator-initiated studies are supported by Servier and Pfizer. He has received honoraria for his contributions to professional educational seminars supported by the pharmaceutical industry (including Servier, Pfizer, AstraZeneca and Eli Lilly). No other competing interests declared.