Morningness-eveningness scores predict outcomes differentially for depressed patients attending morning vs. afternoon day treatment streams

ABSTRACT

At the Center for Addiction and Mental Health (CAMH) Integrated Day Treatment (IDT) program, each patient attends either a morning stream or an afternoon stream, but not both. We examined whether subjective chronotype, or the time of day an individual prefers to be most active and alert, predicted treatment outcomes differentially in depressed patients attending the morning vs. afternoon IDT streams. The Horne-Östberg Morningness-Eveningness Questionnaire (MEQ) was administered before IDT treatment to 203 consecutive patients experiencing a major depressive episode. Multiple regression was used to predict change in depression and quality of life scores based on treatment stream (morning or afternoon), baseline MEQ scores and the treatment stream by MEQ interaction. The treatment stream by MEQ interaction was a highly significant predictor of both depression and quality of life change scores. Post-hoc analyses based on established MEQ categories revealed that definite evening chronotypes had significantly better responses in the morning stream than did morning chronotypes, and significantly worse responses in the afternoon stream relative to moderate evening or neutral chronotypes. There were insufficient morning chronotypes in the afternoon stream to assess clinical responses for this subgroup. In the morning stream only, there was a significant positive correlation between the change in MEQ scores after four weeks of IDT treatment (i.e. a shift to greater morningness) and the decrease in depression scores (r = .36, p = .003), consistent with a therapeutic phase advance in circadian rhythms. In sum, these preliminary data suggest that definite evening chronotypes may have the greatest relative benefit from attending the morning vs. afternoon IDT stream. As patients currently select which IDT stream they will attend, future work based on randomized treatment assignment and using passive actigraphy to assess circadian phase is currently planned to extend these preliminary findings.

KEYWORDS:

• Horne-Östberg Morningness-Eveningness scale (MEQ)
• day treatment
• major depressive episode
• prediction of response

Acknowledgments

The authors owe special thanks to Katie Bishop who co-ordinated subject recruitment and all aspects of the IDT assessment protocol. The authors thank the clinical and support staff of the IDT for their extensive help throughout this project.

Additional information

Funding

This work was supported by the Cameron Parker Holcombe Wilson Chair in depression studies at CAMH and University of Toronto (held by Dr. Levitan) and the Center for Addiction and Mental Health Integrated Day Treatment (IDT) Program. The funding sources had no involvement in the collection, analysis and interpretation of data, in the writing of the report or in the decision to submit the article for publication;CAMH Integrated Day Treatment Program; Cameron Holcombe Wilson Chair in Depression Studies, CAMH and University of Toronto;