The relationship between chronotype and personality among patients with alcohol dependence syndrome: Pilot study

Validation of the Caen Chronotype Questionnaire: Exploring the added value of amplitude and correlations with actigraphy

Chronotype self-report instruments are time and cost-efficient measures to profile diurnal or time-of-day preferences. The Caen Chronotype Questionnaire (CCQ) captures morningness and eveningness (CCQ-ME) and a circadian amplitude dimension for diurnal variation (distinctiveness; CCQ-DI). This study extends prior multilanguage validations for the English version of the CCQ. In total, 628 participants enrolled from a UK working population (mean age 30.34 ± 8.36 years, 61.3% female) including a subset of shift workers (n = 179; mean age 27.62 ± 5.95 years, 49.2% female). A subsample of participants also wore a consumer-grade actigraph device (Fitbit Charge 4) for seven days to compare chronotype estimates with objective sleep-wake parameters (n = 22; mean age 27.05 ± 3.99 years, 81.8% female, 90.9% worked standard daytime schedules, and 9.1% worked rotating shifts). All participants completed online chronotype measures, including the CCQ and Morningness-Eveningness Questionnaire (MEQ), depressive symptoms (Patient Health Questionnaire; PHQ-9), sleep quality (Pittsburgh Sleep Quality Index; PSQI), and other outcome measures. Results from the Confirmatory Factor Analysis (CFA) offer support for a two-factor structure of the CCQ in an English-speaking sample, highlighting how individual preferences for the timing of activities is associated with chronotype (morningness-eveningness; ME) and a second subjective amplitude dimension (DI). However, in contrast with the original CCQ structure, a more parsimonious solution and best overall fit involved the reduction of the original 16-item questionnaire (8 items per factor) to 4 ME items and 5 DI items. Convergent validity with the reduced CCQ scale (rME) and the MEQ was also established. The CCQ was sensitive in discriminating differences in actigraphic sleep-wake timings between morning-and evening-oriented individuals. Regression models demonstrated that amplitude (CCQ-DI) was a significant predictor explaining most of the variance in depressive symptoms (PHQ-9) compared to other variables. Overall, the English version of the CCQ was shown to be a robust tool in estimating chronotype in a sample of adults based in the UK.

Circadian rhythms and inflammatory diseases of the liver and gut

Circadian rhythms play a central role in maintaining metabolic homeostasis and orchestrating inter-organ crosstalk. Research evidence indicates that disruption to rhythms, which occurs through shift work, chronic sleep disruption, molecular clock polymorphisms, or the consumption of alcohol or high-fat diets, can influence inflammatory status and disrupt timing between the brain and periphery or between the body and the external environment. Within the liver and gut, circadian rhythms direct the timing of glucose and lipid homeostasis, bile acid and xenobiotic metabolism, and nutrient absorption, making these systems particularly susceptible to the effects of disrupted rhythms. In this review, the impacts of circadian disruption will be discussed with emphasis on inflammatory conditions affecting the liver and gut, and the potential for chronotherapy for these conditions will be explored.

Chronotype and poor sleep quality in young adults - a pilot study on the role of rumination

BACKGROUND

Eveningness has been associated with poor sleep quality and depression. However, chronotype has also been shown to be a multidimensional construct, not limited to a merely morningness-eveningness orientation. It has also been proposed that other factors may also mediate the relationship between chronotype and its mental health sequelae. This pilot study explores the role of rumination as a mediator between chronotype and sleep quality, chronotype and depressive symptoms.

METHODS

A sample of 144 participants completed The Morningness-Eveningness-Stability-Scale Improved (MESSi), Pittsburgh Sleep Quality Index (PSQI), Rumination-Reflection Questionnaire (RRQ) and Center for Epidemiologic Studies Depression Scale (CES-D)). The results were tested using Spearman's rank correlation coefficient, multiple linear regression and the Sobel test.

RESULTS

Rumination was linked to poor sleep quality and increased depression. Morning affect and Distinctness (i.e. rigidity, or the subjective amplitude of the circadian rhythm) correlated with rumination. Rumination was a partial mediator of the associations between Morning Affect and sleep quality, Morning Affect and depression.

CONCLUSIONS

Rumination may play a role in the association between chronotype (particularly Morning Affect and Distinction) and sleep quality and depression. The recognition of this association might serve as a basis for clinical psychoeducational and therapeutic programs targeting both adjustment of the circadian rhythm and rumination as a psychopathological sign.

Evening chronotype as a bipolar feature among patients with major depressive disorder: the results of a pilot factor analysis

Objectives:

The bipolar spectrum concept has resulted in a paradigm shift that has affected both the diagnosis and therapy of mood disorders, with bipolarity becoming an indicator of treatment resistance in depression. Evening circadian preference has also been linked to affective disorders. The aim of our study was to confirm the relationship between the severity of depressive symptoms, bipolar features, chronotype, and sleep quality among patients with major depressive disorder.

Methods:

A group of 55 individuals who were recruited from a mental health outpatient clinic completed the following psychometric tools: a Chronotype Questionnaire comprising morningness-eveningness (ME) and subjective amplitude of the rhythm (AM) scales, the Hypomania Checklist 32 (HCL-32), the Beck Depression Inventory (BDI) and the Pittsburgh Sleep Quality Index (PSQI).

Results:

Factor analysis identified two latent components, accounting cumulatively for 58% of variables: depressive symptoms (BDI and PSQI) and bipolarity (ME, AM, and HCL-32). After rotation, ME loading in the first factor increased the result to a significant level. The correlation between the two components was very low.

Conclusions:

Evening chronotype appears to be a bipolarity-related marker, with this relationship being independent of its link to depressive symptoms and sleep quality. Eveningness and high circadian rhythm amplitude may offer promise as diagnostic, prognostic, and therapeutic predictors.

Snacking behavior differs between evening and morning chronotype individuals but no differences are observed in overall energy intake, diet quality, or food cravings

There is a growing body of literature that links chronotype to certain undesirable eating behaviors. However, the relationship between chronotype and dietary intake is poorly characterized among adults in the United States (U.S.). This cross-sectional study examined the associations among chronotype, snacking habits, dietary intake and quality, and food cravings. One-hundred adults living in the U.S. completed the study. Based on the Horne-Östberg Morningness-Eveningness Questionnaire score, an individual was categorized as having either a morning (M)-type, intermediate (I)-type, or evening (E)-type chronotype. Snack intake was assessed using a previously published specialized food frequency questionnaire. Sugar-sweetened beverage (SSB) intake was assessed using the updated version of the Beverage Intake Questionnaire-15. Alcohol misuse was measured using the Alcohol Use Disorders Identification Test-Consumption. Diet quality was obtained using the Diet History Questionnaire III. The validated General Food Cravings Questionnaire-Trait measured participants' food cravings. E-type individuals reported consuming snacks more often over the course of a week than M-types (p = .002) but not I-types. In terms of timing of snacking, E-type individuals consumed more snacks after dinner than M-types (p < .001). E-type individuals consumed more energy-dense snacks (p = .005), especially candies (p = .005), than M-types. However, there were no significant differences in healthy snack frequency, diet quality, energy and macronutrient intake, SSB consumption, alcohol misuse, or food cravings among chronotypes (p > .05, for all). In conclusion, E-type individuals consumed snacks more frequently and later than M-types; however, chronotype was not associated with an individual's energy intake, diet quality, and food cravings, which suggests that chronotype is negligibly associated with weight gain-related behaviors in this population.

Evening chronotype, alcohol use disorder severity, and emotion regulation in college students

The evening chronotype is strongly associated with greater alcohol use, though mechanisms underlying this association are not well understood. The current study evaluated emotion regulation as a potential mechanism linking evening chronotype and alcohol use. Participants were 81 undergraduate students. Chronotype was assessed using the Composite Scale of Morningness (CSM). Alcohol use disorder severity was assessed using the Alcohol Use Disorder Identification Test (AUDIT). Participants recorded daily sleep patterns using an online diary for seven days. Participants then completed a standardized laboratory emotion regulation task. Self-reported affect, high-frequency heart rate variability (HF-HRV), and pre-ejection period (PEP) were measured throughout the task. Sleep duration on non-free days (defined as days when sleep was restricted by morning obligations such as work or school) was evaluated as a moderator. Thirty-one evening chronotypes (CSM scores ≤ 26) were compared to 50 non-evening chronotypes (CSM scores >26). Evening chronotypes reported significantly greater symptoms of alcohol use disorder (F = 4.399, p = .039). In the full sample, emotion regulation was successful for altering affective but not autonomic reactivity to emotional stimuli. There were no chronotype differences in self-reported affect, HF-HRV, or PEP during the emotion regulation task. Longer sleep duration on non-free days was associated with increased HF-HRV during negative emotion regulation among non-evening chronotypes. Moderated mediation revealed that emotion regulation did not mediate the association between evening chronotype and alcohol use, irrespective of sleep duration on non-free days. This study is consistent with the literature on chronotype and substance use, demonstrating that undergraduate evening chronotypes endorse greater severity of alcohol use disorder. Given that emotion regulation did not successfully alter autonomic reactivity to emotional stimuli, emotion regulation as a potential mechanism linking chronotype and alcohol use remains inconclusive. Longer sleep duration appears to be protective for non-evening chronotypes in terms of parasympathetic control during the regulation of negative emotions.

Chronotype and Mental Health: Recent Advances

PURPOSE OF REVIEW

Evening chronotype is increasingly recognized as a correlate of, and perhaps a contributor to, mental illness. The current review evaluates recent evidence for the association between chronotype and mental illness and putative mechanisms underlying the association, while highlighting methodological advances and areas of research that are relatively under-examined in the literature.

RECENT FINDINGS

While evening chronotype is most consistently associated with severity of mood disorder symptoms, emerging evidence implicates evening chronotype as a transdiagnostic correlate of substance use severity, anxiety symptoms, attentional difficulties, and maladaptive behaviors such as aggression. Longitudinal studies point to the possibility that evening chronotype precedes problematic substance use, depression, and anxiety. Neural processes related to reward and affective regulation may underlie associations between evening chronotype and illness. The literature on chronotype and mental illness has evolved to (1) include associations with a broader range of psychiatric symptom profiles; (2) explore underlying mechanisms; and (3) expand on earlier research using objective measures and more sophisticated study designs. In addition to further mechanistic research, additional work is needed to examine the stability and key subcomponents of the chronotype construct, as well as more attention to pediatric and special populations. This research is needed to clarify the chronotype-mental health relationship, and to identify how, when, and what aspects of chronotype can be targeted via therapeutic interventions.

Eveningness and its possibility of predicting burnout symptoms among physicians and nurses – preliminary results

Introduction.

A sense of burnout may seriously impair one’s functioning and well-being. It may also hamper the quality of care over a patient. The present study therefore assesses sleep quality and chronotype as predictors of a sense of burnout in physicians and nurses of a district hospital.

Material and methods.

The study group comprised 16 physicians and 31 nurses of a district hospital in Central Poland. The participants completed the Link Burnout Questionnaire (LBQ), Chronotype Questionnaire, and Pittsburgh Sleep Quality Inventory. A linear regression model was constructed for each LBQ dimension by means of stepwise elimination. Each model was adjusted to empirical data (p<0.05).

Results.

A rise in Psychophysical exhaustion was predicted by greater scores for Morningness-Eveningness (ME) and Distinctness (DI) of the rhythm. A higher ME score was associated with higher scores in Relationship deterioration and Sense of professional ineffectiveness, with the latter also associated with presence in the nurses group. The nurses group also demonstrated higher Disillusionment and Psychophysical exhaustion scores than the physicians group.

Conclusions.

Eveningness predicted greater burnout in the studied sample. Thus, chronotype should be considered an important burnout risk factor and it can act as a starting point for devising behavioural interventions.

The role of affective temperaments assessed by the Temperament Evaluation of Memphis, Pisa and San Diego-Autoquestionnaire (TEMPS-A) in the relationship between morningness-eveningness and bipolarity

BACKGROUND

Growing number of studies indicates a link between eveningness chronotype, affective temperaments and bipolarity, both in patients with mood disorders and in general population. Given these tripartite associations, we hypothesized that the effect of circadian preferences on the bipolarity may be mediated by the temperamental traits.

METHODS

The study included 1449 subjects (402 men and 1047 women). They all fulfilled a web-based questionnaire, consisting of the Composite Scale of Morningness (CSM), Mood Disorder Questionnaire (MDQ), Hypomania Checklist-32 (HCL-32) and the Temperament Evaluation of the Memphis, Pisa and San Diego-Autoquestionnaire (TEMPS-A). The role of temperamental traits in the relationship between morningness-eveningness and bipolarity was assessed using mediation analysis.

RESULTS

Morningness is correlated with lower bipolarity measured by the MDQ and HCL-32, and to lower scores of depressive, cyclothymic, irritable and anxious temperaments of the TEMPS-A. There is no significant association between morningness and hyperthymic traits. Cyclothymic and irritable traits are full mediators of the association between chronotype and bipolarity, influencing bipolarity independently from circadian preferences. Depressive and anxious traits are partial mediators of this association, increasing the effect of eveningness on bipolarity.

LIMITATIONS

The indirectness of the findings in the web-based study and disproportion of participants' gender.

CONCLUSIONS

Our study confirmed that eveningness is associated with bipolarity. In case of depressive and anxious temperaments, bipolarity is associated stronger with eveningness than with the TEMPS-A scores. On the other hand, cyclothymic and irritable temperaments were associated with bipolarity independently from circadian preferences.

Conscientiousness but not agreeableness mediates females' tendency toward being a morning person

Individuals differ in their chronotype, and some are identified as morning ones and others as evening ones. Earlier studies showed that women were higher on morningness, conscientiousness, and agreeableness. In this study, we aimed at exploring the mediational effects of conscientiousness and agreeableness in the relationship of gender and morningness-eveningness. Participants were 669 university students. Results supported positive relationships between morningness and conscientiousness and agreeableness and between conscientiousness and agreeableness. Females were higher on all these three variables. Mediation analyses suggested that the effect of gender (here females) on chronotype (here morningness) was mediated by conscientiousness but not agreeableness so that after the mediation partially occurred, the gender's effect did not remain significant anymore. This study backed our hypothesis that conscientiousness might play a more pronounced role than the intrinsic diurnal rhythm concerning the sex differences in chronotype.

Sleep quality, chronotype, temperament and bipolar features as predictors of depressive symptoms among medical students

The assessment of risk factors is a crucial step in the prevention and treatment of affective disorders and should encompass personal dispositions. The aim of this study was to assess the value of chronotype and temperament as independent predictors of depressive symptoms among medical students. The study surveyed 140 students of the Faculty of Medicine with a battery of questionnaires: the Beck Depression Index (BDI), Hypomania Checklist 32 (HCL-32), Pittsburgh Sleep Quality Index (PSQI), Chronotype Questionnaire and Eysenck Personality Questionnaire Revised. The results were tested using Pearson's correlation quotient and general linear model. Ten percent of the participants demonstrated a BDI score suggestive of clinically significant depressive symptoms. BDI score correlated positively with HCL-32 score. A rise in BDI was independently predicted by elevated Neuroticism and PSQI scores and morningness. Those effects were independent from each other and from other parameters of the model. The presence of depressive symptoms might be associated with bipolar features among medical students. Poor sleep quality predicted depressive symptoms, similarly to Neuroticism and independently of temperament and chronotype. Future studies on the associations between personal dispositions and mood disorders among medical students are required to help identify those at greater risk of developing affective illness. Effective prophylaxis and early intervention are warranted to ensure better treatment results.