Morningness-eveningness, depressive symptoms, and emotional eating: a population-based study

Examining the Efficacy of Mindfulness-Based Interventions in Treating Obesity, Obesity-Related Eating Disorders, and Diabetes Mellitus

Mindfulness is the practice of focusing one's attention and energy on the present moment with an accepting attitude and an open mindset. Its adoption is increasingly utilized in addressing health concerns, particularly in the realm of nutrition. Mindful eating seeks to adjust disordered eating patterns by cultivating intentional awareness of the physical, mental, and emotional aspects of eating. Mindfulness techniques may involve meditation, breathing exercises, and simply being more attentive in daily activities. Integrating mindfulness into a nutrition strategy may improve digestion, foster a healthier relationship with food, and lead to making better choices aligned with overall well-being. This critical review aims to examine recent prevailing studies on the effects of mindfulness-based interventions (MBI) on weight regulation, eating disorders related to obesity, emotional eating, and diabetes management. For the methods section, the study utilized the Google Scholar and PubMed databases, employing the Medical Subject Headings (MeSH) descriptors. The search included articles published up to September 2024, resulting in a total of 122 articles gathered using various keyword combinations. Results show that out of the 122 studies, 28 articles were common, leaving a total of 94 articles. They included 33 randomized controlled trials (RCTs), 17 systematic reviews and meta-analyses, 11 observational studies, 14 reviews, and 19 others. The findings from these studies demonstrate the positive impact of MBI on conditions such as binge eating disorder, weight loss, emotional eating, and diabetes-related issues. In conclusion, the review supports the growing evidence suggesting that the incorporation of mindfulness can play a crucial role in managing obesity, eating disorders, and their associated consequences. However, further research is necessary to establish a definitive understanding of its effectiveness and how to integrate it into healthcare practices.

Investigating the association between night eating symptoms and chronotype: the mediating role of depressive symptoms in a sample of Italian university students

PURPOSE

This study aimed to understand the relationship between night eating symptoms, chronotype, and depressive symptoms among Italian university students.

METHODS

The study assessed 905 students using self-report questionnaires, including the night eating questionnaire (NEQ), the Morningness-Eveningness Questionnaire (MEQ), and the Beck depression Inventory (BDI). The correlation between variables was analyzed using Pearson correlation analysis, and mediation analysis was conducted using SPSS PROCESS Macro to estimate the association between variables.

RESULTS

Among the students' sample, the mean age was 25.54 years, with an age range between 18 and 35, 68.7% were women, 15% were morning types with MEQ scores of 59 and above, 64.8% were intermediate types with MEQ scores between 42 and 58, 20.3% were evening types with MEQ scores of 41 and below, and 3.6% reached the criteria for night eating syndrome (NES). There was an inverse correlation between MEQ and BDI scores, higher BDI and lower MEQ scores, and a significant inverse correlation between NEQ and MEQ scores, higher NEQ and lower MEQ scores. Individuals with higher NEQ scores had higher BDI scores, indicating a significant positive correlation between night eating symptoms and depressive symptoms. MEQ had a statistically significant negative direct effect on BDI and NEQ variables. The direct impact of BDI on NEQ was positive and statistically significant. The indirect negative effect of MEQ on NEQ through BDI was also determined to be statistically significant.

CONCLUSION

The study found that depressive symptoms played a significant mediating role in the link between eveningness and night eating, with a partial mediation. Evening chronotype was associated with an elevated night eating score. The findings emphasize the importance of chronotherapeutic approaches in treating night eating. However, further research is necessary to elucidate the intricate relationship between these variables.

LEVEL OF EVIDENCE

Level III. Evidence obtained from well-designed cohort or case-control analytic studies.

Circadian realignment and depressed mood: A systematic review

Chronotherapeutic interventions aimed at realigning the circadian system can improve depression. This systematic review evaluated the current evidence for circadian realignment as an antidepressant mechanism. A comprehensive search was conducted in studies that implemented a chronotherapeutic intervention in samples with depression and/or delayed sleep/circadian timing using PubMed, EMBASE, Cochrane Central Register of Controlled Trials (Wiley), Europe PMC, and PsycINFO. The Downs and Black checklist was used to evaluate study quality. There were 58 studies included, of which 23 studies reported the association between realignment and depression. Circadian realignment was associated with improved depression in studies that included participants with baseline delays and elevated depression. Randomized clinical trials measuring circadian phase markers are needed to further elucidate circadian realignment as an antidepressant mechanism.

The association of energy or macronutrient intake in three meals with depression in adults with cardiovascular disease: the United States National Health and Nutrition Examination Survey, 2003-2018

BACKGROUND

There is growing evidence that individuals with cardiovascular disease (CVD) are more likely to develop depression. The timing of food intake can significantly alter the body's circadian rhythm and affect the occurrence of depression. Currently, it is unknown whether and how energy or macronutrient intake times are associated with depression in adults with CVD.

OBJECTIVE

To evaluate dietary energy or macronutrient intake (across three meals) associations with depression in adults with CVD in a nationally representative sample.

METHODS

The study population consisted of 3,490 U.S. adults with CVD (including 554 with depression) from the National Health and Nutrition Examination Survey 2003-2018. Energy and macronutrient intake was measured by a 24-h dietary recall, and depression was diagnosed by the Patient Health Questionnaire (PHQ-9, score ≥ 10). According to dietary energy or macronutrient intake across three meals, adults with CVD were divided into five groups. Logistic regression analysis was performed to examine associations between energy or macronutrient intake and depression after adjusting for a series of confounding factors, including age, gender, education level, household income, smoking status, drinking status, physical activity, marital status, skipping breakfast/lunch/dinner, total energy, carbohydrate, protein, dietary fiber, SFA, MUFA, and PUFA intake, T2DM and hypertension status, and BMI. Dietary substitution models were used to explore changes in depression risk when 5% dietary energy intake at dinner or lunch was substituted with energy intake at breakfast.

RESULTS

When compared with participants in the lowest quintile of breakfast energy intake, those who received energy intake in the highest quintile at breakfast were associated with lower depression risk in those with CVD, and the adjusted odds ratio (OR) was 0.71 (95% CI, 0.51 to 0.91). When compared with participants in the lowest quintile of lunch or dinner energy intake, the risk of depression did not exhibit statistical significance when lunch or dinner energy intake was in the highest quintile, and the adjusted ORs were 1.08 (95% CI, 0.65 to 1.83) and 0.92 (95% CI, 0.62 to 1.37), respectively. Isocalorically replacing 5% of total energy at dinner or lunch with breakfast was associated with 5% (OR: 0.95, 95% CI 0.93 to 0.97) and 5% (OR: 0.95, 95% CI 0.93 to 0.96) lower risk of depression, respectively.

CONCLUSIONS

High energy intake at breakfast may be associated with a lower risk of depression in those with CVD. We should focus on the potential role of breakfast energy intake in preventing the onset of depression.

Exploring factors influencing late evening eating and barriers and enablers to changing to earlier eating patterns in adults with overweight and obesity

Late evening eating is a potential risk factor for overconsumption and weight gain. However, there is limited qualitative research investigating the complex factors that influence late evening eating in adults living with obesity. Identifying the factors that influence late evening eating can inform interventions to reduce late evening eating and associated health risks. Therefore, this study aimed to: i) explore factors that contribute to eating late, and ii) apply the Capability, Opportunity, and Motivation Behaviour (COM-B) model to understand the barriers and enablers to changing to earlier food intake timings in UK adults who report eating late. Semi-structured interviews with seventeen participants [32.47 ± 6.65 years; 34.68 ± 7.10 kg/m2; 71% female (n = 12); 41% White (n = 7)] investigated reasons for late evening eating and the potential barriers and enablers to changing to earlier eating patterns. Thematic analysis identified four main contributors to late evening eating: 1) internal signals (e.g., feeling hungry in the evening); 2) external and situational factors (e.g., work schedules and the food-rich environment); 3) social factors (e.g., interactions with family) and 4) behavioural and emotional factors (e.g., personal preferences and negative feelings in the evening). Time constraints and work schedules were identified as main barriers to changing to earlier eating patterns. Whereas, having high motivation (e.g., contentment with eating earlier in the evening) and interpersonal support were identified as main enablers to eating earlier. This study provides in-depth insights into the psychological, social, and environmental factors contributing to late evening eating. The findings highlight potential targets for future interventions to facilitate earlier eating times in individuals at risk of overweight and obesity.

Validation of the English-language version of the Morningness-Eveningness-Stability-Scale-improved (MESSi), and comparison with a measure of sleep inertia

The Morningness-Eveningness-Stability-Scale-improved (MESSi) assesses three components of circadian functioning: Morning Affect (time to fully awaken), Eveningness (orientation/preference for evening activity), and Distinctness (amplitude of diurnal variations in functioning). Following the original German version, translations of the MESSi (including Spanish, Turkish, and Chinese) have been validated, but validity evidence for the English-language version has been lacking. The current study tested the factor structure, internal consistency, and predicted correlations of the English-language MESSi. A sample of 600 adults from an online recruitment platform (aged 18-78, mean = 41.31, SD = 13.149) completed an online survey including the MESSi, reduced Morningness-Eveningness Questionnaire (rMEQ), Sleep Inertia Questionnaire (SIQ), and measures of personality and depressive symptoms. Exploratory factor analysis exactly reproduced the three-component structure of Morning Affect (MA), Eveningness, and Distinctness, with all items loading strongly on their respective component. Confirmatory factor analysis of this structure showed acceptable fit. The three subscales showed good internal consistency and replicated previously reported correlations with depressive symptoms, sleep inertia, sleep quality, and personality. Further factor analysis combining the items of the MESSi, rMEQ, and SIQ replicated a previously found seven-factor structure: Cognitive, Emotional, and Physiological sleep inertia (SI), Responses to SI (including one MA item); Duration of SI (one SIQ item, 3/5 MA items); Morningness-Eveningness (MESSi Eveningness items, plus 3/5 rMEQ items); Distinctness (5/5 MESSi items). In conclusion, the English-language MESSi shows sound psychometric properties, but Morning Affect may be more suitably characterised as a measure of sleep inertia duration, rather than morningness preference.

Perils of the nighttime: Impact of behavioral timing and preference on mental health in 73,888 community-dwelling adults

Mental health is independently influenced by the inclination to sleep at specific times (chronotype) and the actual sleep timing (behavior). Chronotype and timing of actual sleep are, however, often misaligned. This study aims to determine how chronotype, sleep timing, and the alignment between the two impact mental health. In a community-dwelling cohort of middle- and older-aged adults (UK Biobank, n = 73,888), we examined the impact of chronotype (questionnaire-based), the timing of behavior (determined with 7-day accelerometry), and the alignment between the two on mental, behavioral, neurodevelopmental disorders (MBN), depression, and anxiety, as assessed through ICD-10 codes. As compared to morning types with early behavior (aligned), morning types with late behavior (misaligned) had an increased risk of having MBN, depression, and anxiety (p's<0.001). As compared to evening-types with late behavior (aligned), however, evening-types with early behavior (misaligned) had a decreased risk of depression (p < 0.01), with a trend for MBN (p = 0.04) and anxiety (p = 0.05). Longitudinal analyses, in which the likelihood of developing de novo mental health disorders was associated with chronotype, behavioral timing, and alignment between the two, confirmed cross-sectional findings. To age healthily, individuals should start sleeping before 1AM, despite chronobiological preferences.

Is the Caloric Midpoint Associated with Food Cravings and Food Intake in Pregnant Women?

Objective: The field of chrononutrition suggests that mealtime can influence food intake. Previous studies have linked the caloric midpoint - defined as the time at which 50% of the daily energy is consumed - with different aspects of food consumption. However, its relationship with food craving remains unexplored. This cross-sectional study aimed to investigate the association between caloric midpoint, food craving, and food consumption in pregnant women.Methods: The study comprised 233 pregnant women classified as early eaters (caloric midpoint ≤ 1:00pm) and late eaters (caloric midpoint >1:00pm). Food craving were assessed using Food Craving Trait and State Questionnaires. Energy and nutrient intake, as well as mealtimes, were assessed using a 24-h food recall.Results: No association between caloric midpoint and food craving was found. However, late eaters consumed more calories (2039.47 kcal vs 1843.44 kcal; p < 0.001), carbohydrates (255.06 g vs 211.12 g; p = 0.002), total fat (73.1 g vs 64.8 g; p = 0.003), monounsaturated fat (21.33 mg vs 18.59 mg; p = 0.002) and saturated fat (24.37 mg vs 22.21 mh; p = 0.01) and had higher consumption of calories and macronutrients in the first (calories: 275.63 vs 213.41, p = 0.007; carbohydrate: 170.42 vs 142.54, p = 0.01; total fat: 56.49 vs 50.17, p = 0.04) and second (calories: 213.21 vs 151.59, p = 0.04; carbohydrate: 130.44 vs 96.6, p = 0.04; protein: 15.17 vs 13.71, p = 0.03) afternoon snack, dinner (calories: 576.89 vs 412.4, p < 0.001; carbohydrate: 230.76 vs 169.45, p < 0.001; protein: 80.48 vs 68.9, p = 0.02; total fat: 212.77 vs 147.12, p < 0.001) and late-night snack (calories: 135.75 vs 68.3, p = 0.04; total fat: 13.23 vs 22.45, p = 0.04) than early eaters.Conclusion: Pregnant women who concentrate their meals at later times consumed more calories, macro and micronutrients throughout the day and in the night meals when compared to early eaters.

Mendelian randomization studies of depression: evidence, opportunities, and challenges

BACKGROUND

Major depressive disorder (MDD) poses a significant social and economic burden worldwide. Identifying exposures, risk factors, and biological mechanisms that are causally connected to MDD can help build a scientific basis for disease prevention and development of novel therapeutic approaches.

METHODS

In this systematic review, we assessed the evidence for causal relationships between putative causal risk factors and MDD from Mendelian randomization (MR) studies, following PRISMA. We assessed methodological quality based on key elements of the MR design: use of a full instrumental variable analysis and validation of the three key MR assumptions.

RESULTS

We included methodological details and results from 52 articles. A causal link between lifestyle, metabolic, inflammatory biomarkers, particular pathological states and MDD is supported by MR investigations, although results for each category varied substantially.

CONCLUSIONS

While this review shows how MR can offer useful information for examining prospective treatment targets and better understanding the pathophysiology of MDD, some methodological flaws in the existing literature limit reliability of results and probably underlie their heterogeneity. We highlight perspectives and recommendations for future works on MR in psychiatry.

Associations of timing of food intake with energy intake, eating behaviour traits and psychosocial factors in adults with overweight and obesity

Introduction

Whether a late distribution of food intake impacts obesity through increased energy intake remains uncertain and the behavioural characterization of late eating needs to be further investigated. The first objective of this study was to assess the associations between late eating and body mass index (BMI) and total energy intake (TEI), and whether TEI mediates the association between late eating and BMI. The second objective was to assess the associations between late eating and eating behaviour traits or psychosocial factors and whether eating behaviour traits mediate the association between late eating and TEI.

Methods

Baseline data from 301 individuals (56% women, age = 38.7 ± 8.5 years; BMI = 33.2 ± 3.4 kg/m²), who participated in four weight loss studies were used in this cross-sectional study. Total energy intake was assessed using a three-day food record from which the percentage of TEI after 17:00 and after 20:00 was calculated. Eating behaviour traits and psychosocial factors were assessed with questionnaires. Pearson correlations and mediation analyses adjusted for age, sex, underreporting of energy intake, sleep duration and bedtime were performed.

Results

Percent TEI after 17:00 and after 20:00 were associated with TEI (r = 0.13, p = 0.03 for both), and TEI mediated the association between percent TEI after 17:00 and BMI (β = 0.01 ± 0.01, 95% CI: 0.001, 0.02). Percent TEI after 17:00 was associated with disinhibition (r = 0.13, p = 0.03) and percent TEI after 20:00 was associated with susceptibility to hunger (r = 0.13, p = 0.03), stress (r = 0.24, p = 0.002) and anxiety (r = 0.28, p = 0.0004). In women, disinhibition mediated the association between percent TEI after 17:00 and TEI (β = 3.41 ± 1.43, 95% CI: 0.92, 6.47). Susceptibility to hunger mediated the association between percent TEI after 20:00 and TEI (β = 0.96 ± 0.59, 95% CI: 0.02, 2.34) in men and women.

Conclusion

Late eating is associated with TEI and suboptimal eating behaviours which could contribute to explaining the association between timing of food intake and obesity.

Evening types as determined by subjective and objective measures are more emotional eaters

OBJECTIVE

This study aimed to determine the association between being an evening type (ET; defined subjectively by the Morning-Evening Questionnaire or objectively by the dim-light melatonin onset [DLMO] timing) and reporting emotional eating (EE) behaviors.

METHODS

Cross-sectional analyses were conducted in 3964 participants (four international cohorts: ONTIME and ONTIME-MT [both Spain], SHIFT [the US], and DICACEM [Mexico]), in which chronotype (Morning-Evening Questionnaire), EE behaviors (Emotional Eating Questionnaire), and dietary habits (dietary records or food-frequency questionnaire) were assessed. Among 162 participants (ONTIME-MT subsample), additional measures of DLMO (physiological gold standard of circadian phase) were available.

RESULTS

In three populations, ETs presented with a higher EE score than morning types (p < 0.02); and they made up a higher proportion of emotional eaters (p < 0.01). ETs presented with higher scores on disinhibition/overeating as well as food craving factors and experienced these behaviors more frequently than morning types (p < 0.05). Furthermore, a meta-analysis showed that being an ET was associated with a higher EE score by 1.52 points of a total of 30 points (95% CI: 0.89-2.14). The timing of DLMO in the early, intermediate, and late objective chronotypes occurred at 21:02 h, 22:12 h, and 23:37 h, with late types showing a higher EE score (p = 0.043).

CONCLUSIONS

Eveningness associated with EE in populations with different cultural, environmental, and genetic backgrounds. Individuals with late DLMO also showed more EE.

Morning affect or sleep inertia? Comparing the constructs and their measurement

The construct of Morning Affect (MA; alertness upon awakening/time required to feel fully awake) emerged from exploratory factor analysis of morningness-eveningness questionnaires, and while it has been equated with morningness-eveningness preference it has much conceptual overlap with sleep inertia (SI; the transitional state between sleep and being fully awake). The current study compared questionnaire measures of these constructs to help clarify their inter-relationships. A volunteer sample of 453 students at an English-medium university in China completed an online survey including the Sleep Inertia Questionnaire (SIQ), the Morningness-Eveningness-Stability-Scale-improved (MESSi), with subscales for MA, Eveningness, and Distinctness (amplitude of diurnal variation), and the reduced Morningness-Eveningness Questionnaire (rMEQ). Measures of depression, sleep quality, mindfulness, and personality were also included. Exploratory factor analysis of the SIQ, MESSi, and rMEQ items revealed seven factors: Cognitive, Emotional, and Physiological SI, Responses to SI (including one MA item), and Duration of SI (one SIQ item, 3/5 MA items, and one rMEQ item); Morningness-Eveningness (MESSi Eveningness items, plus 3/5 rMEQ items); Distinctness (3/5 MESSi items). These results suggest that Morning Affect may be better characterised as a general measure of sleep inertia, and may contribute to ongoing development/refinement of questionnaire measures of circadian functioning.

Role of chronotype in dietary intake, meal timing, and obesity: a systematic review

CONTEXT

Recent studies show that dietary habits and obesity seem to be influenced by chronotype, which reflects an individual's preference for the timing of sleeping, eating, and activity in a 24-hour period.

OBJECTIVE

This review aimed to analyze the association of chronotype with dietary habits, namely energy and macronutrient intakes, meal timing, and eating patterns, as well as with obesity.

DATA SOURCES

PubMed/MEDLINE, LILACS, and Google Scholar databases were searched between 2004 and 2020. Study selection was performed by 2 authors independently; disagreements on eligibility of articles were resolved by a third author. After assessment of 12 060 abstracts, 43 studies (21 articles on obesity; 13 on food consumption, meal timing, and eating patterns; and 9 that addressed both obesity and dietary behavior) were included.

DATA EXTRACTION

A standard form was used to extract study design, country, number of participants, method of chronotype determination, and main findings.

DATA ANALYSIS

Approximately 95% of included studies showed an association between eveningness and at least 1 unhealthy eating habit. Morningness was associated with regular consumption of fresh and minimally processed foods. In addition, about 47% of studies showed a higher association between late types and obesity.

CONCLUSION

Late types are more likely to present unhealthy eating habits, such as eating late at night, skipping breakfast often, and eating processed/ultraprocessed foods, while early types are more likely to have healthy and protective habits, such as eating early and eating predominantly fresh/minimally processed foods. Intermediate types tend to have a pattern of health and eating more similar to early types than to late types. Late types are also more likely to present higher weight and body mass index than early or intermediate types.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42021256078.

Association between Chronotype, Physical Activity and Sedentary Behaviour: A Systematic Review

BACKGROUND

The aim of this systematic review is to compile and assess the scientific evidence about the relationship between chronotypes and physical activity (PA). Methods: A systematic review was executed using a structured electronic search in PubMED, Cochrane Library, PsycInfo and Trip Database. The searches employed keywords such as chronotype, sleep, acrophase, chronotype preference, morningness, physical activity and sedentary, using MeSH terms. JBI critical tools were used to appraise methodological aspects.

RESULTS

This systematic review includes 23 studies and a total of 505,375 participants. The results show that evening chronotypes are associated with less PA and more time in sedentary activities. It occurs independently of the instruments used to collect information about chronotype and PA. Nevertheless, this association could be mitigated in young populations and university stages.

CONCLUSIONS

The chronotypes are clearly associated with the PA level and the sedentary behaviour, especially in the population over their mid-twenties. Evening chronotypes are associated with less PA and more time in sedentary activities compared to morning chronotypes.

Chronotype Profile, Stress, Depression Level, and Temporomandibular Symptoms in Students with Type D Personality

Background: Despite a growing interest in the types of human circadian activity, different chronotypes and personality-related issues have been rarely studied. It has already been emphasized that ‘stress personality’ is considered a risk factor for certain psychosomatic diseases and may be a temporomandibular disorders (TMDs) predictor. Therefore, an attempt has been made to analyze the chronotypes, stress levels, stress factors, and the occurrence of depression and TMDs in students with type D personalities. People with this personality trait tend to experience negative emotions more—depression, anxiety, anger, or hostility—yet may have a negative image of themselves and report somatic complaints. Aim: The aim of this study was to analyze the importance of the chronotype profile for the level of stress perceived, as well as for the occurrence of depression and TMDs in people with type D personalities. Material and Methods: The study has been conducted on a group of 220 physical therapy students. The study group G1 consisted of 110 participants with type D personalities, the control group G2 consisted of the same number of participants without the stress personality. All participants have been analyzed for the chronotype (MEQ), stress perception (PSS10), the occurrence of depression (Beck scale-BDI), the occurrence of TMDs symptoms and have completed the stress factor assessment questionnaire during the study, followed by DS14 questionnaire—a tool for assessing the prevalence of type D personality. Results: In students with type D personalities (G1), the definitely evening and evening chronotypes have been significantly more predominant than in the control group (G2). A significantly higher number of stressors and TMDs symptoms have been observed in the respondents from the G1 group than in the control group (<0.001). Univariate logistic regression analysis showed that type D personality was strongly associated with a more frequent occurrence of all TMD symptoms. Additionally, a significant influence of the evening chronotype on the occurrence of type D personality was observed. Among the potential confounding variables, female gender and a mild and moderate degree of depression have an impact on the occurrence of type D personality (p < 0.05). In the multivariate model, adjusted with the above-mentioned factors, an increased risk of the type D personality trait was found. Conclusion: The evening chronotype and type D personality may imply greater feelings of stress, greater depression, and more frequent symptoms of TMDs in young adults.

Sex differences in the relationship between morningness-eveningness components, mood and well-being among Bangladeshi university students

On the Morningness/Eveningness (M/E) continuum, eveningness has been related to mood disorder and poor well-being. M/E differs between men and women throughout their lifespan. However, there is a lack of information on sex differences in the relationship between M/E, mood, and well-being. This study aimed to test sex differences in the M/E, mood, and well-being relationship with consideration of two components of M/E, morning affect, and morning preference. A sample of 981 Bangladeshi university students (607 men) aged 18 to 27 (M = 21.95) completed Bangla versions of the Composite Scale of Morningness (CSM), BRUnel Mood Scale (BRUMS), and Positive Mental Health scale (PMH-scale) through an online survey. Multiple regression analyses were used to test the relationship of M/E components with mood and well-being. The results showed that the relationship between M/E, mood, and well-being was greater in women than in men. A lower score on both M/E components was related to higher negative moods (anger, confusion, depression, fatigue, and tension) and poor well-being. In regression analysis, only morning affect was found to be significant, which means that morning affect mainly contributes to the relation between M/E, mood, and well-being. Finally, sex by morning affect interaction indicated that the relation was higher for women. Therefore, higher eveningness could be more hazardous for women than men. Greater insight into the independent contribution of morning affect may facilitate understanding of the chronotype effects on psychological outcomes in men and women.

Mental health indices may fully mediate the relationship between morningness-eveningness and disease control among adult asthma patients

Objective: The aim of this study was to assess the association between morningness-eveningness and disease control with consideration of mental state as a mediator and the control of confounding factors among adult asthma patients.Methods: This is a cross-sectional study, which included a nonrandom sample of N = 66 patients from an outpatient unit with a confirmed asthma diagnosis, who gave an informed consent and completed a set of questionnaires: a survey comprising questions about sociodemographic and clinical characteristics, the Asthma Control Test (ACT), the Composite Scale of Morningness (CSM), and the General Health Questionnaire (GHQ-28). Mediation models were created separately for each GHQ-28 dimension (somatic symptoms, anxiety/insomnia, social dysfunction and depressive symptoms), for a total score and for four GHQ-28 dimensions together, considered as mediators.Results: Low morning affect was related to poor disease symptom control among patients with asthma. The effect was fully mediated by non-psychotic mental health indices. Evening-time preference was associated with a rise in asthma control, and mediated by somatic symptoms and anxiety/insomnia, when controlled for morning affect.Conclusions: The current study underlines the significance of assessment of both individual morningness-eveningness preference and mental health in the management of asthma symptoms.

Using Mendelian Randomisation methods to understand whether diurnal preference is causally related to mental health

Late diurnal preference has been linked to poorer mental health outcomes, but the understanding of the causal role of diurnal preference on mental health and wellbeing is currently limited. Late diurnal preference is often associated with circadian misalignment (a mismatch between the timing of the endogenous circadian system and behavioural rhythms), so that evening people live more frequently against their internal clock. This study aims to quantify the causal contribution of diurnal preference on mental health outcomes, including anxiety, depression and general wellbeing and test the hypothesis that more misaligned individuals have poorer mental health and wellbeing using an actigraphy-based measure of circadian misalignment. Multiple Mendelian Randomisation (MR) approaches were used to test causal pathways between diurnal preference and seven well-validated mental health and wellbeing outcomes in up to 451,025 individuals. In addition, observational analyses tested the association between a novel, objective measure of behavioural misalignment (Composite Phase Deviation, CPD) and seven mental health and wellbeing outcomes. Using genetic instruments identified in the largest GWAS for diurnal preference, we provide robust evidence that early diurnal preference is protective for depression and improves wellbeing. For example, using one-sample MR, a twofold higher genetic liability of morningness was associated with lower odds of depressive symptoms (OR: 0.92, 95% CI: 0.88, 0.97). It is possible that behavioural factors including circadian misalignment may contribute in the chronotype depression relationship, but further work is needed to confirm these findings.

Relationship Between Big Five Personality Dimensions, Chronotype, and DSM-V Personality Disorders

Morningness-eveningness (M/E) is an important variable in individual differences and has an impact on many areas of life including general and mental health. In previous work eveningness has shown to correlate to personality disorders (PDs) and mental instability such as psychoticism, depression, and bipolar disorders. Therefore, a relationship between M/E and PDs can be assumed but has never been tested. The aim of this study was to assess a possible relationship between DSM-5-PDs and circadian timing (chronotype; M/E). We used the Morningness-Eveningness Stability Scale improved and clock time-based measurements, the PID-5 brief version, and the Big Five brief version. Sample: N = 630; mean age: 27.76 years, SD: 11.36 years; 137 male, 489 female, 4 diverse. In this short screening a relationship between eveningness and DSM-5-personality traits, (evening-oriented participants showing a higher PID-5 score: morningness -0.208/p < 0.001; eveningness: 0.153/p < 0.001) was found. Moreover, participants with high levels of distinctness (fluctuations of the perceived energy level during the day) are prone to PDs too, with distinctness being the best predictor for a high PID-5 score in this sample (0.299/p < 0.001). In the regression analysis, neuroticism, agreeableness, conscientiousness, and extraversion contributed significantly to the model with higher scores on extraversion, agreeableness and conscientiousness being related to lower scores on the PID-5. Neuroticism was positively related to PID-5 scores. Later midpoint of sleep (higher eveningness) was associated with higher PID-5 scores, as were higher fluctuations/amplitude during the day.

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

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.

A six-factor structure of individual variation in the tendencies to become sleepy and to sleep at different times of the day

A multidimensional approach has been previously applied for modeling and assessment of individual differences in the ability to sleep or to stay awake at certain clock hours. More recently the 19 time-point Visuo-verbal Judgment Task (VJT) has been proposed to predict changes in sleepiness level from the morning hours to the next day afternoon. The dimensionality of the VJT has not been explored so far. We applied a structural model of individual variation in sleep-wake behavior and habits for explaining the pattern of relationship between the VJT's dimensions yielded by rotation of principal components with eigenvalue>1. The responses to 19 items of the VJT, 72 items of 6-scale Sleep Wake Pattern Assessment Questionnaire (SWPAQ) and 60 items of 6-scale Sleep-Wake Adaptability Test (SWAT) were collected from 1037 survey participants. Factor analyses yielded 4 factorial dimensions of morning (08:00-11:00), daytime (12:00-20:00), nighttime (21:00-04:00), and after 24 h sleepiness (06:00-12:00 next day). The model was found to be capable to explain the correlations among 4 constructs of the VJT as well as the correlations among previously developed scales of the SWPAQ and SWAT. The results confirmed the predictive power of the model and its applicability for multidimensional assessments in chronobiological and chronopsychological studies.

Chronobiological traits predict the restrained, uncontrolled, and emotional eating behaviors of female university students

Although significant associations between diurnal preference and restrained eating behaviors were previously reported, such reports are scarce and, in some respects, inconclusive. In this cross-sectional survey of 567 female university students aged between 17 and 23 years, we tried to clarify and extend the previous findings on chronobiological correlates of these behaviors. We administered the three-Factor-Eating-Questionnaire Revised and three questionnaires designed to assess trait-, ability-, and state-like differences in the domain of chronobiology, the Morningness-Eveningness Questionnaire (MEQ), the Sleep-Wake Pattern Assessment Questionnaire, and the Munich ChronoType Questionnaire, respectively. Statistical analyses included factor, correlation, and regression analyses. We found that any of three aspects of unhealthy eating behaviors (i.e., lack of cognitive eating restraint, uncontrolled eating, and emotional eating) was linked to one or more dimensions of individual chronobiological differences. We explained the previously reported inconclusive results by the differential relationship of two subconstructs of diurnal preferences to eating behaviors. For instance, such relationship was found for two (morning and evening) subscales of the MEQ. Cognitive eating restraint and uncontrolled eating were related to the morning subscale, while emotional eating was related to the evening subscale. These associations were supported by the associations revealed for morning vs. evening components of earliness-lateness assessed with two other questionnaires, (e.g., morning lateness and sleep offset vs. evening lateness and sleep onset, respectively). We conclude that unhealthy eating behaviors seem to be linked to unhealthy sleep-wake habits and behaviors and to inabilities to wake or sleep on demand at certain times of the day.

Morning affect, eveningness, and amplitude of diurnal variation: associations with parent adult-child relationships, and adult attachment style

Eveningness, as opposed to other chronotypes, in childhood and adolescence is associated with more parental conflicts, such as regarding bed and rising times, which might adversely influence future relationships with parents, and adult attachments. The current survey of 524 Chinese university students (mean = 20.05 and range 18-36 years of age) investigated whether eveningness shows these adverse associations. Morning affect and amplitude distinctness facets of circadian functioning were also assessed. It was found that eveningness is not related to adults' perception of current parental relationships, or to adult attachment security, but low morning affect and stronger amplitude distinctness were associated with perception of more fatherly control, less regard for parents, and more attachment insecurity, and these were related to poorer wellbeing. These findings indicate that components of circadian functioning are related to the quality of adult relationships. Further research is needed to confirm these findings and establish explanatory mechanisms for these associations.

[Eating behavior, sleep self-assessment and personality traits of students with extreme chronotypes]

OBJECTIVE

To identify the differences in eating behavior, sleep self-assessment and personality traits in students with extreme chronotypes.

MATERIAL AND METHODS

Students (n=350), aged 17 to 23 years, with extreme chronotypes (owls/larks) were studied. Eating behavior was assessed with the Three-Factor Eating Questionnaire (TFEQ-R18). Evaluation of the condition of the cycle sleep-wakefulness (sleep quality, sleep hygiene, daytime sleepiness) and psychophysiological differences (Eysenck Personality Questionnaire, Spielberger-Khanin anxiety inventory and the Taylor Manifest Anxiety Scale (TMAS); the Stress test) was performed.

RESULTS AND CONCLUSION

Higher neuroticism, psychoticism and anxiety, low resistance to stress, reduced quality and hygiene of sleep with increased daytime sleepiness are found in people with evening preferences in comparison with the morning chronotype. Eating behavior according to TFEQ-R18 is characterized by a lack of cognitive restraint. The results may indicate preclinical health disorders, which are affected by lifestyle factors. The number of alcohol consumers and smokers is two and more than three times higher, respectively, among students with evening chronotype. The changes identified in people with evening chronotype require additional attention to student's health.

Circadian Functioning and Quality of Life in Substance Use Disorder Patients With and Without Comorbid Major Depressive Disorder

Aim: Although a relationship between circadian disruption and development of several psychiatric disorders, such as major depressive disorder (MDD) and substance use disorder (SUD), has been observed, knowledge on this area is scarce yet. Therefore, this study aims to analyze the circadian functioning and quality of life (QOL) in SUD patients with and without comorbid MDD, two highly prevalent clinical entities with difficult therapeutic management. Methods: One hundred sixty-three male patients under treatment, 81 with SUD and 82 with SUD comorbid major depressive disorder (SUD + MDD), were evaluated. For the circadian functioning assessment, we calculated Social Jet Lag (SJL) and used the reduced Morningness-Eveningness Questionnaire (rMEQ) and the Pittsburgh Sleep Quality Index (PSQI). QOL was measured using the shortened version of the World Health Organization's Quality of Life Questionnaire (WHOQOL-BREF). We collected sociodemographic and clinical variables to evaluate their possible influence on the circadian functioning. Intergroup differences among the variables were examined by different analyses of covariance (ANCOVA and MANCOVA). The possible relationships of quantitative clinical variables with rMEQ, PSQI, and WHOQOL-BREF were explored using bivariate correlation analysis. Results: Lower SJL appears in the SUD + MDD group compared with SUD. The intermediate-type was more prevalent in the SUD group, while a higher percentage of morning-type patients was found in the SUD + MDD. Sleep quality (including latency and daytime dysfunction) was worse for SUD + MDD patients than for SUD even after controlling age and age of SUD onset variables. Last, QOL was poorer in patients with SUD + MDD and, for them, psychological health had a negative relationship with SJL and severity of depression. Conclusions: Our data support and extend previous findings indicating that SUD + MDD is associated with worse clinical characteristics, more sleep problems, and poorer QOL than SUD patients. These results underline the importance of a precise assessment of these measurements in future studies conducted in SUD patients with/without MDD comorbidity that could be considered from a therapeutic point of view.

Associations of chronotype, Big Five, and emotional competences with perceived stress in university students

This study aimed to investigate the associations between individual difference factors (chronotype, Big Five, emotional competences) and perceived stress in French university students. In total, 362 students agreed to take part (M _age = 20.19 ± 1.75 years). Participants completed the Caen Chronotype Questionnaire, Big Five Inventory, the Profile of Emotional Competences, and the Perceived Stress Scale. Results showed that chronotype amplitude (+), eveningness chronotype (+), neuroticism (+), conscientiousness (-), and intrapersonal emotional competences (-) were important for perceived stress. These findings have theoretical and practical implications in terms of identifying students who might benefit most from stress management interventions.

Emotional eating and obesity in adults: the role of depression, sleep and genes

Stress and other negative emotions, such as depression and anxiety, can lead to both decreased and increased food intake. The term 'emotional eating' has been widely used to refer to the latter response: a tendency to eat in response to negative emotions with the chosen foods being primarily energy-dense and palatable ones. Emotional eating can be caused by various mechanisms, such as using eating to cope with negative emotions or confusing internal states of hunger and satiety with physiological changes related to emotions. An increasing number of prospective studies have shown that emotional eating predicts subsequent weight gain in adults. This review discusses particularly three lines of research on emotional eating and obesity in adults. First, studies implying that emotional eating may be one behavioural mechanism linking depression and development of obesity. Secondly, studies highlighting the relevance of night sleep duration by showing that adults with a combination of shorter sleep and higher emotional eating may be especially vulnerable to weight gain. Thirdly, an emerging literature suggesting that genes may influence body weight partly through emotional eating and other eating behaviour dimensions. The review concludes by discussing what kind of implications these three avenues of research offer for obesity prevention and treatment interventions.

The Cognitive, Behavioral, and Emotional Aspects of Eating Habits and Association With Impulsivity, Chronotype, Anxiety, and Depression: A Cross-Sectional Study

Background and objectives: Understanding behavioral issues associated with eating would provide important insight into obesity development and possibly procure ways to prevent its occurrence or to treat it. This study's objectives were to examine links between cognitive, behavioral, and emotional aspects of eating habits and chronotype, impulsivity, anxiety, and depression among university students.

Subjects and methods: The following questionnaires were used: TFEQ-R 18, UPPS-short, HADS, and MEQ. All participants gave their informed written consent prior to enrolment.

Results: Among females, increased BMI was associated to uncontrolled eating and emotional eating, while in males, BMI was associated to emotional eating only. In males, no associations of BMI with impulsivity were found while in females they were present. Chronotype scores were positively correlated to cognitive restraint and negatively to uncontrolled eating among males. No associations were found for females. CR was lower among females with higher depression scores, while higher anxiety scores were associated to UE among males.

Conclusions: This was a cross-sectional study of three cognitive and emotional domains related to eating habits among university students (young adults). Results showed significant correlations between BMI, TFEQ-R18 scores, impulsivity and anxiety or depression. Future studies should replicate findings in samples of individuals with different aspects of eating disorders such as binge eating disorder, food addiction or bulimia nervosa.

Eveningness Is Associated With Greater Depressive Symptoms in Type 2 Diabetes Patients: A Study in Two Different Ethnic Cohorts

BACKGROUND

Eveningness is associated with greater depressive symptoms in the general population. Depression and type 2 diabetes (T2D) commonly coexist. We aimed to explore the association between morningness-eveningness and depressive symptoms in T2D patients in the United States and in Thailand.

PARTICIPANTS

T2D patients (n = 182) from an endocrinology clinic in Chicago, Illinois, and six hospitals in Thailand (n = 251) were enrolled.

METHODS

Diabetes history was collected. Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression scale (CES-D). The Chicago cohort completed the Morningness-Eveningness Questionnaire (MEQ) and the Thai cohort completed the Composite Scale of Morningness (CSM). Sleep quality was assessed using the Pittsburg Sleep Quality Index (PSQI).

RESULTS

The mean (SD) CES-D score was 13.7 (9.1) in Chicago and 11.9 (6.4) in Thailand. In Chicago participants, after adjusting for age, sex, ethnicity, hemoglobin A1c, insulin use, and PSQI score, greater eveningness (lower MEQ scores) was associated with higher CESD scores (B = -0.117, p = 0.048). In Thai participants, after adjusting for age, sex, and PSQI score, eveningness (lower CSM score) was associated with higher CES-D score (B = -0.147, p = 0.016). In both cohorts, however, eveningness was not independently associated with the likelihood of being in the at-risk range for clinical depression (CES-D ≥ 16).

CONCLUSIONS

Eveningness is independently associated with greater depressive symptoms in T2D in two different ethnic cohorts. The results support the association between individual differences in circadian rhythms and psychological functioning in T2D.

Prevalence of food addiction and association with stress, sleep quality and chronotype: A cross-sectional survey among university students

AIMS

Food addiction (FA) is defined as an insatiable desire for the consumption of specific high-fat, high-sugar foods beyond the required energy needs for sustenance. The aims of this study were to determine FA prevalence and to assess associations between FA, stress, sleep quality and chronotype among university students.

DESIGN AND SETTING

A cross-sectional questionnaire-based survey conducted among students from 8 major Lebanese universities. Students were randomly selected and requested to fill the questionnaire. 644 agreed to participate. Data were collected via a face-to-face interview conducted by 2 trained research assistants.

PARTICIPANTS

University students above 18 years old and not presenting any cognitive or chronic illnesses, after signing a written consent form.

MEASUREMENTS

In addition to sociodemographic data, all participants filled the following self-administered standardized and validated questionnaires: Yale Food Addiction Scale (YFAS), Perceived Stress Scale (PSS), Morningness-Eveningness Questionnaire (MEQ) and Pittsburgh Sleep Quality Index (PSQI).

FINDINGS

FA prevalence was 10.1% with a 95% confidence interval of 7.8-12.4%. 56.5% of all the participants had a poor quality of sleep, whereas 81.2% of the participants presenting FA experienced a poor sleep quality (versus 57.2% when no FA is present). 70.2% of the students presented an intermediate chronotype, 20.5% an evening chronotype and 8.7% a morning chronotype. Age, smoking status, BMI, PSS and PSQI remained significantly correlated to the continuous YFAS score in multivariate analysis.

CONCLUSIONS

Our findings denote the importance of identifying and offering help to individuals presenting a FA because it is frequent among youth, associated to higher BMI and to smoking, seems to be a very intertwined and complex phenomenon coexisting with other neuropsychiatric problems, such as stress and poor sleep quality and therefore can have serious health implications.

Uncontrolled eating: a unifying heritable trait linked with obesity, overeating, personality and the brain

Many eating-related psychological constructs have been proposed to explain obesity and overeating. However, these constructs, including food addiction, disinhibition, hedonic hunger, emotional eating, binge eating and the like all have similar definitions, emphasizing loss of control over intake. As questionnaires measuring the constructs correlate strongly (r > 0.5) with each other, we propose that these constructs should be reconsidered to be part of a single broad phenotype: uncontrolled eating. Such an approach enables reviewing and meta-analysing evidence obtained with each individual questionnaire. Here, we describe robust associations between uncontrolled eating, body mass index (BMI), food intake, personality traits and brain systems. Reviewing cross-sectional and longitudinal data, we show that uncontrolled eating is phenotypically and genetically intertwined with BMI and food intake. We also review evidence on how three psychological constructs are linked with uncontrolled eating: lower cognitive control, higher negative affect and a curvilinear association with reward sensitivity. Uncontrolled eating mediates all three constructs' associations with BMI and food intake. Finally, we review and meta-analyse brain systems possibly subserving uncontrolled eating: namely, (i) the dopamine mesolimbic circuit associated with reward sensitivity, (ii) frontal cognitive networks sustaining dietary self-control and (iii) the hypothalamus-pituitary-adrenal axis, amygdala and hippocampus supporting stress reactivity. While there are limits to the explanatory and predictive power of the uncontrolled eating phenotype, we conclude that treating different eating-related constructs as a single concept, uncontrolled eating, enables drawing robust conclusions on the relationship between food intake and BMI, psychological variables and brain structure and function.

Pulling the covers in electronic health records for an association study with self-reported sleep behaviors

The electronic health record (EHR) contains rich histories of clinical care, but has not traditionally been mined for information related to sleep habits. Here, we performed a retrospective EHR study based on a cohort of 3,652 individuals with self-reported sleep behaviors documented from visits to the sleep clinic. These individuals were obese (mean body mass index 33.6 kg/m²) and had a high prevalence of sleep apnea (60.5%), however we found sleep behaviors largely concordant with prior prospective cohort studies. In our cohort, average wake time was 1 hour later and average sleep duration was 40 minutes longer on weekends than on weekdays (p < 10^-12). Sleep duration varied considerably as a function of age and tended to be longer in females and in whites. Additionally, through phenome-wide association analyses, we found an association of long weekend sleep with depression, and an unexpectedly large number of associations of long weekday sleep with mental health and neurological disorders (q < 0.05). We then sought to replicate previously published genetic associations with morning/evening preference on a subset of our cohort with extant genotyping data (n = 555). While those findings did not replicate in our cohort, a polymorphism (rs3754214) in high linkage disequilibrium with a previously published polymorphism near TARS2 was associated with long sleep duration (p < 0.01). Collectively, our results highlight the potential of the EHR for uncovering the correlates of human sleep in real-world populations.

Prospective study of chronotype and incident depression among middle- and older-aged women in the Nurses' Health Study II

BACKGROUND

Prior cross-sectional studies have suggested that being a late chronotype is associated with depression and depressive symptoms, but prospective data are lacking.

METHODS

We examined the association between chronotype and incident depression (defined as self-reported physician/clinician-diagnosed depression or antidepressant medication use) in 32,470 female participants of the Nurses' Health Study II cohort who self-reported their chronotype (early, intermediate or late) and were free of depression at baseline in 2009 (average age: 55 yrs). Women updated their depression status on biennial questionnaires in 2011 and 2013. We used multivariable (MV)-adjusted Cox proportional hazards models to estimate hazard ratios (HR) and 95% confidence intervals (95%CI) for incident depression across chronotype categories (i.e., early, intermediate, and late chronotypes).

RESULTS

Across a follow-up period of 4 years, we observed 2,581 cases of incident depression in this cohort. Compared to intermediate chronotypes, early chronotypes had a modestly lower risk of depression after MV adjustment (MVHR = 0.88, 95%CI = 0.81-0.96), whereas late chronotypes had a similar risk of 1.06 (95%CI = 0.93-1.20); the overall trend across chronotype categories was statistically significant (ptrend<0.01). Results were similar when we restricted analyses to women who reported average sleep durations (7-8 h/day) and no history of rotating night shift work at baseline.

CONCLUSIONS

Our results suggest that chronotype may influence the risk of depression in middle-to older-aged women. Additional studies are needed to confirm these findings and examine roles of both environmental and genetic factors to further our understanding of the role of chronotype in the etiology of mood disorders.

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.

Associations between chronotype, sleep disturbances and seasonality with fatigue and inflammatory bowel disease symptoms

Growing number of studies suggests link between circadian rhythms and inflammatory bowel diseases (IBD) manifestation. We hypothesize that: 1) IBD are associated with increased eveningness and sleep disturbances; 2) eveningness and sleep disturbances are related to more severe IBD symptoms. In total, 129 participants were enrolled to this study, divided into three groups: 34 Crohn's disease (CD) patients, 38 ulcerative colitis (UC) patients and 57 healthy controls (HC) group. They all fulfilled a questionnaire, consisting of the Composite Scale of Morningness (CSM), Seasonal Pattern Assessment Questionnaire (SPAQ), Pittsburgh Sleep Quality Index, Inflammatory Bowel Disease Questionnaire (IBDQ) and Multidimensional Fatigue Inventory (MFI). Multiple regression models controlled for age and sex revealed that in CD group higher eveningness measured with CSM was associated with higher general fatigue, physical fatigue, mental fatigue and reduced motivation measured by MFI. Lower CSM morning affect is associated with greater general fatigue, physical fatigue and more reduced activity. Greater seasonality scores are associated with increased physical fatigue and more reduced activity and motivation. Lower sleep quality measured with PSQI is associated with higher physical fatigue and more reduced activity. Correlational analysis revealed that higher seasonality and lower sleep quality are associated with increased systemic and bowel symptoms and decreased emotional and social functions measured with IBDQ. In UC group, eveningness is associated with greater general fatigue, physical fatigue and more reduced activity. Higher CSM morning affect is associated with decreased general fatigue, physical fatigue and less reduced activity. Higher CSM circadian preference scores are associated with decreased general and physical fatigue, and less reduced activity. Increased seasonality is associated with more physical fatigue. Lower sleep quality is associated with greater general and physical fatigue. To our best knowledge this is the first study evaluating associations between chronotype and sleep disturbances with IBD symptoms. We have found that chronotype preferences, whose role in IBD has been until now overlooked, may be one of the important factors contributing to fatigue in this clinical group.

The concept of chronotypes and its clinical importance for depressive disorders

Chronobiology and chronobiological research deal with time-dependent physiological processes and behavioral correlates as well as their adaptation to environmental conditions. Chronobiological research is presently focused on the impact of circadian rhythms on human behavior. In the last three decades, chronobiology has established itself as an independent area of research evolving to an important field of clinical psychology and psychiatry. In this overview, the results of studies on the clinical importance of chronotypes are summarized. The main focus is on the role of chronotype in depressive disorders.

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.

Chronotype and Psychiatric Disorders

PURPOSE OF REVIEW

Chronotype, reflecting interindividual differences in daily activity patterns and sleep-wake cycles, is intrinsically connected with well-being. Research indicates increased risk of many adverse mental health outcomes for evening-type individuals. Here, we provide an overview of the current evidence available on the relationship between chronotype and psychiatric disorders.

RECENT FINDINGS

The association between eveningness and depression is well established cross-sectionally, with preliminary support from longitudinal studies. The mechanisms underlying this relationship warrant further research; deficient cognitive-emotional processes have recently been implicated. Eveningness is associated with unhealthy lifestyle habits, and the propensity of evening types to addiction has been recognized. Chronotype may also be implicated in disordered eating.

SUMMARY

Eveningness is associated with depression-including seasonal affective disorder (SAD)-and substance dependence, while support for a relation with anxiety disorders and psychosis is lacking. In bipolar disorder, chronotype is linked to depression but not mania. Eveningness is also related to sleep disturbances and poor lifestyle habits, which may increase risk for psychiatric disorders.

Associations of depression and seasonality with morning-evening preference: Comparison of contributions of its morning and evening components

Despite predominance of positive findings on associations of morning-evening preference with seasonality and depression, it remains to be clarified whether morning and evening components of this preference equally contribute to these associations and whether these associations persist after accounting for confounding variables. Data on retrospectively reported seasonal changes in well-being, mood, and behaviors were collected from 2398 residents of West Siberia, South and North Yakutia, Chukotka, Alaska, and Turkmenistan. Other self-reports included mental and physical health, sleep duration, and adaptabilities of the sleep-wake cycle. Depression was found to be linked to morning rather than evening component of morning-evening preference, i.e., morning lateness. Morning lateness was also linked to retrospectively reported degree of seasonal changes rather than to severity of problems associated with such changes. Variation in morning-evening preference explained not more than 2% and 4% of the total variation in depression and seasonality, respectively. The associations became even weaker but remained significant after accounting for other differences between respondents, such as their gender, age, physical health, and adaptability of their sleep-wake cycle. These results have practical relevance for understanding of the roles playing by morning earliness and insensitivity to seasonal changes in the environment to protection against different mood disorders.

Modifiable lifestyle behaviors, but not a genetic risk score, associate with metabolic syndrome in evening chronotypes

Evening chronotype associates with health complications possibly via lifestyle factors, while the contribution of genetics is unknown. The aim was to study the relative contributions of genetics, lifestyle, and circadian-related physiological characteristics in metabolic risk of evening chronotype. In order to capture a biological contribution to chronotype, a genetic-risk-score (GRS), comprised of 15 chronotype-related variants, was tested. Moreover, a wide range of behavioral and emotional eating factors was studied within the same population. Chronotype, lifestyle, and metabolic syndrome (MetS) outcomes were assessed (n = 2,126), in addition to genetics (n = 1,693) and rest-activity/wrist-temperature rhythms (n = 100). Evening chronotype associated with MetS and insulin resistance (P < 0.05), and several lifestyle factors including poorer eating behaviors, lower physical activity and later sleep and wake times. We observed an association between higher evening GRS and evening chronotype (P < 0.05), but not with MetS. We propose a GRS as a tool to capture the biological component of the inter-individual differences in chronotype. Our data show that several modifiable factors such as sedentary lifestyle, difficulties in controlling the amount of food eaten, alcohol intake and later wake and bed times that characterized evening-types, may underlie chronotype-MetS relationship. Our findings provide insights into the development of strategies, particularly for evening chronotype.

Larks, owls, swifts, and woodcocks among fruit flies: differential responses of four heritable chronotypes to long and hot summer days

PURPOSE

Drosophila melanogaster and our own species share (Homo sapiens) the history of relatively rapid out-of-Africa dispersal. In Eurasia, they had faced a novel adaptive problem of adjustment of their circadian rhythmicity and night sleep episode to seasonal variation in day length and air temperature. Both species usually respond to heat and a short duration of night by reduction of the amount of night sleep and prolongation of "siesta". To further explore similarities between the two species in the ways of adjustment of their sleep-wake behavior to extreme environmental factors, this study examined the possibility to distinguish four extreme chronotypes among fruit flies and the possibility of the differential response of such chronotypes to light and heat stressors.

MATERIALS AND METHODS

Circadian rhythms of locomotor activity and sleep-wake pattern were tested in constant darkness, and four strains of fruit flies originating from three wild populations of Africa, Europe, and the USA were selected to represent four distinct chronotypes: "larks" (early morning and evening activity peaks), "owls" (late morning and evening peaks), "swifts" (early morning and late evening peaks), and "woodcocks" (late morning and early evening peaks). The circadian rhythms and sleep efficiency of the selected chronotypes were further tested under such extreme conditions as either long day (LD20:4 at 20°C) or a combination of LD20:4 with hot temperature (29°C).

RESULTS

Despite the identity of such experimental conditions for four chronotypes, their circadian rhythms and sleep timing showed significantly distinct patterns of response to exposure to heat and/or long days. All two-way repeated measures analysis of variances yielded a significant interaction between chronotype and time of the day (P<0.001).

CONCLUSION

An experimental study of heritable chronotypes in the fruit fly can facilitate a search for genetic underpinnings of individual variation in vulnerability to circadian misalignment, maladaptive sleep-wake behavior, and sleep disorders.

State- and trait-like variation in morning and evening components of morningness-eveningness in winter depression

PURPOSE

Evening preference (eveningness) can be a risk factor for depression and a shift toward morning preference (morningness) can occur in response to treatment. A study of winter depression provides possibility to longitudinally evaluate state- and trait-like variation in morningness-eveningness during treatment in winter and remission in summer.

MATERIAL AND METHODS

Female patients with winter depression and controls without a psychiatric history (n = 54 and 32 with mean age ± standard deviation of 34.4 ± 11.0 and 35.7 ± 9.5 years, respectively) were treated with two-hour bright light for a week during winter period. Some of them (n = 40 and 19, respectively) were then restudied in summer. Measures obtained during the winter period from patients before and after treatment were compared to those obtained from controls and from the same patients in the summer period. Among compared measures, there were self-assessments of state- and trait-like differences in morning and evening components of morningness-eveningness.

RESULTS

The groups of depressed patients and controls differed in self-assessments of morning but not evening component of morningness-eveningness. The difference in state-like variation in morning component became non-significant after treatment and in summer. On the other hand, trait-like variation in this component demonstrated adequate test-retest (winter-summer) reliability, i.e. a shift toward trait-like eveningness persisted in patients in the summer.

CONCLUSIONS

The observed normalization of state-like variation in morning component of morning-evening preference can be mainly explained by the disappearance of such depressive symptoms as lack of energy, social withdrawal, loss of interest in once enjoyable activities, etc.

Not later, but longer: sleep, chronotype and light exposure in adolescents with remitted depression compared to healthy controls

The relationship between sleep and adolescent depression is much discussed, but still not fully understood. One important sleep variable is self-selected sleep timing, which is also referred to as chronotype. Chronotype is mostly regulated by the circadian clock that synchronises the internal time of the body with the external light dark cycle. A late chronotype as well as a misalignment between internal time and external time such as social jetlag has been shown to be associated with depressive symptoms in adults. In this study, we investigated whether adolescents with remitted depression differ from healthy controls in terms of chronotype, social jetlag and other sleep-related variables. For this purpose, we assessed chronotype and social jetlag with the Munich ChronoType Questionnaire (MCTQ), subjective sleep quality with the Pittsburgh Sleep Quality Index (PSQI) and used continuous wrist-actimetry over 31 consecutive days to determine objective sleep timing. Given the potentially mediating effect of light on chronotype and depressive symptoms, we measured light exposure with a light sensor on the actimeter. In our sample, adolescents with remitted depression showed similar chronotypes and similar amounts of social jetlag compared to controls. However, patients with remitted depression slept significantly longer on work-free days and reported a worse subjective sleep quality than controls. Additionally, light exposure in remitted patients was significantly higher, but this finding was mediated by living in a rural environment. These findings indicate that chronotype might be modified during remission, which should be further investigated in longitudinal studies.

ARNTL, CLOCK and PER3 polymorphisms - links with chronotype and affective dimensions

Recently, seven single nucleotide polymorphisms (SNPs) of ARNTL, TIM and PER3 genes were found associated with affective temperaments in bipolar disorder patients. This study aimed to test whether a) the same associations appear in a non-clinical sample; b) the SNPs are related to other affective dimensions; c) the SNPs underpin the associations between chronotype and affective temperaments/dimensions. Three hundred thirty-eight university students completed the Temperament Scale of Memphis, Pisa, Paris and San Diego Auto-questionnaire, the Centre for Epidemiological Studies Depression Scale, the Perceived Stress Scale, the General Health Questionnaire, the Seasonal Pattern Assessment Questionnaire and the Composite Scale of Morningness. Seven SNPs of the ARNTL, TIM and PER3 genes were genotyped. According to nominal significance, ARNTL rs7107287 was associated with a cyclothymic temperament, depressive and stress symptoms, general mental health and perceived negative impact of seasonality, while TIM rs10876890 was associated with a hyperthymic temperament, and the TIM rs2291738 was associated with chronotype. Different SNPs were related to chronotype and affective temperaments/dimensions, and therefore, they seem to not underpin relationships between chronotype and affective dysfunction, that is, in the present study, eveningness was related to dysthymic, cyclothymic and irritable temperaments, more symptoms of depression, stress, worse mental health and a negative impact of seasonality, while morningness was related to hyperthymic temperament. The SNPs associations need further replication given that they did not achieve Bonferroni criteria of significance accounting for the number of polymorphisms considered and tests conducted.

Chronotype preference matters for depression in youth

Morningness/eveningness (M/E) preference is an important circadian rhythm indicator with strong individual variation. M/E chronotype has been found to be correlated with depression in adults, yet the relationship is less clear in children and adolescents. Additionally, poor sleep quality is another commonly studied risk factor for depression. The aims of the present study are to investigate the independent effects of M/E chronotype on youth depression using both self-report and parental-report questionnaires. We also evaluated how poor sleep quality may affect the relationship through a mediating or moderating effect. In total, 2,139 students attending grades 1 to 7 participated in this study. They completed questionnaires regarding M/E chronotype, depression, and sleep quality. A total of 1,708 parents also participated and filled out parental-reports of emotional and behavioral problems of their children. The prevalence of self- and parental-report depression was 16.8% and 12.8% among young students, respectively. Overall, 15.4% of the students were the eveningness type. Being an eveningness type was independently associated with self-report depression after adjustment for poor sleep quality (OR = 1.86, 95% CI = 1.07-3.24). We also observed that poor sleep quality mediated the influence of M/E chronotype on self-report depression among students aged 7-13 years (p < 0.001). On the other hand, being an eveningness type was associated with a number of parental-report emotional and behavioral problems in the students, in addition to depression, although these associations become non-significant after adjusted for poor sleep quality. Our results demonstrate the importance of M/E chronotype on youth depression and poor sleep quality partly mediates this effect.