Abstract
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.
Similar content being viewed by others
References
Roenneberg T, Kuehnle T, Juda M et al (2007) Epidemiology of the human circadian clock. Sleep Med Rev 11:429–438. doi:10.1016/j.smrv.2007.07.005
Daan S, Beersma DG, Borbély AA (1984) Timing of human sleep: recovery process gated by a circadian pacemaker. Am J Physiol 246:161–183
Wang X-S, Armstrong MEG, Cairns BJ et al (2011) Shift work and chronic disease: the epidemiological evidence. Occup Med (Lond) 61:78–89. doi:10.1093/occmed/kqr001
Gan Y, Yang C, Tong X et al (2015) Shift work and diabetes mellitus: a meta-analysis of observational studies. Occup Environ Med 72:72–78. doi:10.1136/oemed-2014-102150
Hansen J, Lassen CF (2012) Nested case-control study of night shift work and breast cancer risk among women in the Danish military. Occup Environ Med 69:551–556. doi:10.1136/oemed-2011-100240
Vyas MV, Garg AX, Iansavichus AV et al (2012) Shift work and vascular events: systematic review and meta-analysis. BMJ 345:e4800. doi:10.1136/bmj.e4800
Vetter C, Devore EE, Ramin CA et al (2015) Mismatch of sleep and work timing and risk of type 2 diabetes. Diabetes Care 38:1707–1713. doi:10.2337/dc15-0302
American Academy of Sleep Medicine (2001) International classification of sleep disorders, revised: diagnostic and coding manual. Neurology. doi:10.1212/WNL.41.1.160
Wittmann M, Dinich J, Merrow M, Roenneberg T (2006) Social jetlag: misalignment of biological and social time. Chronobiol Int 23:497–509. doi:10.1080/07420520500545979
Roenneberg T, Allebrandt KV, Merrow M, Vetter C (2012) Social jetlag and obesity. Curr Biol 22:939–943. doi:10.1016/j.cub.2012.03.038
Levandovski R, Dantas G, Fernandes LC et al (2011) Depression scores associate with chronotype and social jetlag in a rural population. Chronobiol Int 28:771–778. doi:10.3109/07420528.2011.602445
Parsons MJ, Moffitt TE, Gregory AM et al (2015) Social jetlag, obesity and metabolic disorder: investigation in a cohort study. Int J Obes (Lond) 39:842–848. doi:10.1038/ijo.2014.201
Roenneberg T, Kumar CJ, Merrow M (2007) The human circadian clock entrains to sun time. Curr Biol 17:44–45. doi:10.1016/j.cub.2006.12.011
Roenneberg T, Hut R, Daan S, Merrow M (2010) Entrainment concepts revisited. J Biol Rhythms 25:329–339. doi:10.1177/0748730410379082
Martin JS, Hébert M, Ledoux É et al (2012) Relationship of chronotype to sleep, light exposure, and work-related fatigue in student workers. Chronobiol Int 29:295–304. doi:10.3109/07420528.2011.653656
Allebrandt KV, Teder-Laving M, Kantermann T et al (2014) Chronotype and sleep duration: the influence of season of assessment. Chronobiol Int. doi:10.3109/07420528.2014.901347
Crowley SJ, Van Reen E, LeBourgeois MK et al (2014) A longitudinal assessment of sleep timing, circadian phase, and phase angle of entrainment across human adolescence. PLoS ONE 9:e112199. doi:10.1371/journal.pone.0112199
Crowley SJ, Acebo C, Carskadon MA (2007) Sleep, circadian rhythms, and delayed phase in adolescence. Sleep Med 8:602–612. doi:10.1016/j.sleep.2006.12.002
Roenneberg T, Kuehnle T, Pramstaller PP et al (2004) A marker for the end of adolescence. Curr Biol 14:1038–1039
Kitamura S, Hida A, Watanabe M et al (2010) Evening preference is related to the incidence of depressive states independent of sleep–wake conditions. Chronobiol Int 27:1797–1812. doi:10.3109/07420528.2010.516705
Merikanto I, Lahti T, Kronholm E et al (2013) Evening types are prone to depression. Chronobiol Int 30:719–725. doi:10.3109/07420528.2013.784770
Horne JA, Ostberg O (1976) A self-assessment questionnaire to determine morningness–eveningness in human circadian rhythms. Int J Chronobiol 4:97–110
Roenneberg T, Wirz-Justice A, Merrow M (2003) Life between clocks: daily temporal patterns of human chronotypes. J Biol Rhythms 18:80–90. doi:10.1177/0748730402239679
Roenneberg T (2015) Having trouble typing? What on earth is chronotype? J Biol Rhythms 30:487–491. doi:10.1177/0748730415603835
Zavada A, Gordijn M, Beersma D et al (2005) Comparison of the Munich Chronotype Questionnaire with the Horne–Östberg’s Morningness–Eveningness score. Chronobiol Int 22:267–278. doi:10.1081/CBI-200053536
Keller LK, Zöschg S, Grünewald B et al (2016) Chronotyp und Depression bei Jugendlichen—ein Review. Z Kinder Jugendpsychiatr Psychother 44:113–126. doi:10.1024/1422-4917/a000406
Wittmann M, Paulus M, Roenneberg T (2010) Decreased psychological well-being in late “chronotypes” is mediated by smoking and alcohol consumption. Subst Use Misuse 45:15–30. doi:10.3109/10826080903498952
Meliska C, Martínez L, López A (2011) Relationship of morningness–eveningness questionnaire score to melatonin and sleep timing, body mass index and atypical depressive symptoms in peri- and post-menopausal women Charles. Psychiatry Res 188:88–95. doi:10.1016/j.psychres.2010.12.010.Relationship
Selvi Y, Aydin A, Boysan M et al (2010) Associations between chronotype, sleep quality, suicidality, and depressive symptoms in patients with major depression and healthy controls. Chronobiol Int 27:1813–1828. doi:10.3109/07420528.2010.516380
Kim SJ, Lee YJ, Kim H et al (2010) Age as a moderator of the association between depressive symptoms and morningness–eveningness. J Psychosom Res 68:159–164. doi:10.1016/j.jpsychores.2009.06.010
Drennan MD, Klauber MR, Kripke DF, Goyette LM (1991) The effects of depression and age on the Horne–Ostberg score. J Affect Disord 23:93–98
Chan JWY, Lam SP, Li SX et al (2014) Eveningness and insomnia: independent risk factors of nonremission in major depressive disorder. Sleep 37:911–917. doi:10.5665/sleep.3658
Gaspar-Barba E, Calati R, Cruz-Fuentes CS et al (2009) Depressive symptomatology is influenced by chronotypes. J Affect Disord 119:100–106. doi:10.1016/j.jad.2009.02.021
Alvaro PK, Roberts RM, Harris JK (2014) The independent relationships between insomnia, depression, subtypes of anxiety, and chronotype during adolescence. Sleep Med 15:934–941. doi:10.1016/j.sleep.2014.03.019
Pabst SR, Negriff S, Dorn LD et al (2009) Depression and anxiety in adolescent females: the impact of sleep preference and body mass index. J Adolesc Heal 44:554–560. doi:10.1016/j.jadohealth.2008.11.012
Randler C (2011) Association between morningness-eveningness and mental and physical health in adolescents. Psychol Health Med 16:29–38. doi:10.1080/13548506.2010.521564
Short MA, Gradisar M, Lack LC, Wright HR (2013) The impact of sleep on adolescent depressed mood, alertness and academic performance. J Adolesc 36:1025–1033. doi:10.1016/j.adolescence.2013.08.007
Tzischinsky O, Shochat T (2011) Eveningness, sleep patterns, daytime functioning, and quality of life in Israeli adolescents. Chronobiol Int 28:338–343. doi:10.3109/07420528.2011.560698
de Souza CM, Hidalgo MPL (2014) Midpoint of sleep on school days is associated with depression among adolescents. Chronobiol Int 31:199–205. doi:10.3109/07420528.2013.838575
Fares S, Hermens DF, Naismith SL et al (2015) Clinical correlates of chronotypes in young persons with mental disorders. Chronobiol Int. doi:10.3109/07420528.2015.1078346
Terman JS, Terman M, Lo ES, Cooper TB (2001) Circadian time of morning light administration and therapeutic response in winter depression. Arch Gen Psychiatry 58:69–75
Murray CB, Murphy LK, Palermo TM, Clarke GM (2012) Pain and sleep–wake disturbances in adolescents with depressive disorders. J Clin Child Adolesc Psychol 41:482–490. doi:10.1080/15374416.2012.658613
Forbes EE, Bertocci MA, Gregory AM et al (2008) Objective sleep in pediatric anxiety disorders and major depressive disorder. J Am Acad Child Adolesc Psychiatry 47:148–155. doi:10.1097/chi.0b013e31815cd9bc
Gregory AM, Sadeh A (2015) Annual research review: sleep problems in childhood psychiatric disorders—a review of the latest science. J Child Psychol Psychiatry. doi:10.1111/jcpp.12469
Lovato N, Gradisar M (2014) A meta-analysis and model of the relationship between sleep and depression in adolescents: recommendations for future research and clinical practice. Sleep Med Rev 18:521–529. doi:10.1016/j.smrv.2014.03.006
American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, text revision (DSM-IV-TR), 4th edn. American Psychiatric Association, Washington. doi:10.1176/appi.books.9780890423349
Schneider S, Unnewehr S, Margraf J (2009) Kinder-DIPS—Diagnostisches Interview bei psychischen Störungen im Kindes- und Jugendalter (Kinder-DIPS—diagnostic interview for mental disorders in children and youths). Springer, Heidelberg
Neuschwander M, In-Albon T, Adornetto C et al (2013) Interrater-Reliabilität des Diagnostischen Interviews bei psychischen Störungen im Kindesund Jugendalter (Kinder-DIPS). Z Kinder Jugendpsychiatr Psychother 41:319–334. doi:10.1024/1422-4917/a000247
Beck AT, Steer RA, Brown GK (1996) Beck Depression inventory—second edition, manual. The Psychological Corporation, San Antonio
Kühner C, Bürger C, Keller F, Hautzinger M (2007) Reliability and validity of the Revised Beck Depression Inventory (BDI-II). Results from German samples. Nervenarzt 78:651–656. doi:10.1007/s00115-006-2098-7
Pietsch K, Hoyler A, Frühe B et al (2012) Früherkennung von Depressionen in der Pädiatrie: kriteriumsvalidität des Beck Depressions-Inventar Revison (BDI-II) und des Beck Depressions-Inventar-Fast Screen for Medical Patients (BDI-FS). PPmP Psychother Psychosom Medizinische Psychol. doi:10.1055/s-0032-1314869
Döpfner M, Görtz-Dorten A, Lehmkuhl G (2008) Diagnostik-System für Psychische Störungen im Kindes- und Jugendalter nach ICD-10 und DSM-IV, DISYPS-II. Huber Verlag, Bern
Buysse DJ, Reynolds CF, Monk TH et al (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213
Backhaus J, Junghanns K, Broocks A et al (2002) Test–retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. J Psychosom Res 53:737–740
Roenneberg T, Keller LK, Fischer D et al (2015) Human activity and rest in situ. Methods Enzymol 552:257–283
Vetter C, Wright KP, Winnebeck E, et al. Validation of the Munich Chronotype Questionnaire
Vetter C, Fischer D, Matera JL, Roenneberg T (2015) Aligning work and circadian time in shift workers improves sleep and reduces circadian disruption. Curbio. doi:10.1016/j.cub.2015.01.064
Kantermann T, Sung H, Burgess HJ (2015) Comparing the Morningness—Eveningness Questionnaire and Munich ChronoType Questionnaire to the dim light melatonin onset. J Biol Rhythms 30:449–453. doi:10.1177/0748730415597520
Kitamura S, Hida A, Aritake S et al (2014) Validity of the Japanese version of the Munich ChronoType Questionnaire. Chronobiol Int 31:845–850. doi:10.3109/07420528.2014.914035
Box GEP, Jenkins GM (1970) Time series analysis; forecasting and control. J Time Ser Anal. doi:10.1111/j.1467-9892.2009.00643.x
Preacher KJ, Hayes AF (2004) SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behav Res Methods Instrum Comput 36:717–731. doi:10.3758/BF03206553
Di Milia L, Adan A, Natale V, Randler C (2013) Reviewing the psychometric properties of contemporary circadian typology measures. Chronobiol Int 30:1261–1271. doi:10.3109/07420528.2013.817415
Konttinen H, Kronholm E, Partonen T et al (2014) Morningness-eveningness, depressive symptoms, and emotional eating: a population-based study. Chronobiol Int 31:554–563. doi:10.3109/07420528.2013.877922
Meerlo P, Sgoifo A, Suchecki D (2008) Restricted and disrupted sleep: effects on autonomic function, neuroendocrine stress systems and stress responsivity. Sleep Med Rev 12:197–210. doi:10.1016/j.smrv.2007.07.007
de Kloet ER, Joëls M, Holsboer F (2005) Stress and the brain: from adaptation to disease. Nat Rev Neurosci 6:463–475. doi:10.1038/nrn1683
Sapolsky RM (2000) Glucocorticoids and hippocampal atrophy in neuropsychiatric disorders. Arch Gen Psychiatry 57:925–935. doi:10.1001/archpsyc.57.10.925
Rohde P, Feeny NC, Robins M (2005) Characteristics and components of the TADS CBT approach. Cogn Behav Pract 12:186–197. doi:10.1016/S1077-7229(05)80024-0
Kennaway DJ (2010) Clock genes at the heart of depression. J Psychopharmacol 24:5–14. doi:10.1177/1359786810372980
Gotlib IH (1992) Interpersonal and cognitive aspects of depression. Curr Dir Psychol Sci 1:149–154. doi:10.1111/1467-8721.ep11510319
Hagerty BM, Williams RA, Coyne JC, Early MR (1996) Sense of belonging and indicators of social and psychological functioning. Arch Psychiatr Nurs 10:235–244. doi:10.1016/S0883-9417(96)80029-X
Espiritu RC, Kripke DF, Ancoli-Israel S et al (1994) Low illumination experienced by San Diego adults: association with atypical depressive symptoms. Biol Psychiatry 35:403–407
Haynes P, Ancoli-Israel S, McQuaid J (2005) Illuminating the impact of habitual behaviors in depression. Chronobiol Int 22:279–297. doi:10.1081/CBI-200053546
Wisco BE, Nolen-Hoeksema S (2010) Interpretation bias and depressive symptoms: the role of self-relevance. Behav Res Ther 48:1113–1122. doi:10.1016/j.brat.2010.08.004
Lakdawalla Z, Hankin BL, Mermelstein R (2007) Cognitive theories of depression in children and adolescents: a conceptual and quantitative review. Clin Child Fam Psychol Rev 10:1–24. doi:10.1007/s10567-006-0013-1
Simpkin CT, Jenni OG, Carskadon MA et al (2014) Chronotype is associated with the timing of the circadian clock and sleep in toddlers. J Sleep Res 23:397–405. doi:10.1111/jsr.12142
LeBourgeois MK, Carskadon MA et al (2013) Circadian phase and its relationship to nighttime sleep in toddlers. J Biol Rhythms 15:322–331. doi:10.1016/j.drugalcdep.2008.02.002.A
Zhai L, Zhang H, Zhang D (2015) Sleep duration and depression among adults: a meta-analysis of prospective studies. Depress Anxiety 32:664–670. doi:10.1002/da.22386
Carvalho FG, Hidalgo MP, Levandovski R (2014) Differences in circadian patterns between rural and urban populations: an epidemiological study in countryside. Chronobiol Int 31:442–449. doi:10.3109/07420528.2013.846350
Probst JC, Laditka SB, Moore CG et al (2006) Rural-urban differences in depression prevalence: implications for family medicine. Fam Med 38:653–660
Graw P, Recker S, Sand L (1999) Winter and summer outdoor light exposure in women with and without seasonal affective disorder. J Affect Disord 56:163–169
Everaert J, Koster EHW, Derakshan N (2012) The combined cognitive bias hypothesis in depression. Clin Psychol Rev 32:413–424. doi:10.1016/j.cpr.2012.04.003
Haraszti RÁ, Ella K, Gyöngyösi N et al (2014) Social jetlag negatively correlates with academic performance in undergraduates. Chronobiol Int 31:603–612. doi:10.3109/07420528.2013.879164
Manev H, Uz T (2006) Clock genes: influencing and being influenced by psychoactive drugs. Trends Pharmacol Sci 27:186–189. doi:10.1016/j.tips.2006.02.003
Tan ZL, Bao AM, Zhao GQ et al (2007) Effect of fluoxetine on circadian rhythm of melatonin in patients with major depressive disorder. Neuroendocrinol Lett 28:27–32
Murray G, Michalak EE, Levitt AJ et al (2005) Therapeutic mechanism in seasonal affective disorder: do fluoxetine and light operate through advancing circadian phase? Chronobiol Int 22:937–943. doi:10.1080/07420520500263292
Center for Behavioral Health Statistics and Quality (2015) Behavioral health trends in the United States: results from the 2014 National Survey on Drug Use and Health. In: HHS Publ. No. SMA 15-4927, NSDUH Ser. H-50. http://www.samhsa.gov/data/
Hankin BL, Abramson LY, Moffitt TE et al (1998) Development of depression from preadolescence to young adulthood: emerging gender differences in a 10-year longitudinal study. J Abnorm Psychol 107:128–140. doi:10.1037/0021-843X.107.1.128
Acknowledgements
We thank Verena Pehl and Hannah Luderer for assistance with data collection and Belinda Platt for helpful comments on the manuscript. This work was supported by the Förderprogramm Forschung und Lehre (FöFoLe) Program of the Ludwig-Maximilians-University Munich, Germany (Grant No. 761).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Keller, L.K., Grünewald, B., Vetter, C. et al. Not later, but longer: sleep, chronotype and light exposure in adolescents with remitted depression compared to healthy controls. Eur Child Adolesc Psychiatry 26, 1233–1244 (2017). https://doi.org/10.1007/s00787-017-0977-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00787-017-0977-z