The Association Between Chronotype and Mental Health Problems in a University Population: a Systematic Review of the Literature

Sleep quality mediates the association between chronotype and mental health in young Indian adults

There is increasing recognition of 'higher preference for eveningness' as a potential independent risk factor for poor mental health. To examine the chronotype-mental health relationship while also quantifying the potential roles of poor sleep quality, relevant personality traits, and childhood trauma, we assessed 282 young adults (18-40 years; 195 females) residing in North India, between January and March 2023 (to control for seasonal variation), using self-report measures of diurnal preference, sleep patterns, mental health (depression, anxiety, and stress), personality traits (extraversion, neuroticism, schizotypy, and impulsivity), and childhood trauma. The results showed a significant association between eveningness and poor mental health but this association was fully mediated by poor sleep quality. Neuroticism, emotional abuse and cognitive disorganisation were correlated with eveningness as well as with poor mental health and sleep quality. Neuroticism and emotional abuse, but not cognitive disorganisation, also had indirect effects on mental health via sleep quality. Our findings highlight the crucial role played by sleep quality in the chronotype-mental health relationship.

Prevalence of problematic psychological symptoms in samples of Canadian postsecondary students

OBJECTIVES

To estimate the one-month prevalence of problematic psychological symptoms among Canadian postsecondary students, and to compare the prevalence by student characteristics.

PARTICIPANTS

Three samples of students from two postsecondary institutions.

METHODS

In a cross-sectional study conducted in 2017, we measured self-reported problems related to symptoms of depression, anxiety, and stress using questions from the functioning module of the WHO Model Disability Survey. We used modified Poisson regression modeling to compute prevalence ratios (95%CI) to compare the prevalence by student characteristics.

RESULTS

Our study included 1392 students (participation rate 35%-77%). Across samples, the one-month prevalence of moderate-extreme problems ranged from 50.8%-64.7% for anxiety, 41.2%-60.8% for stress, and 29.4%-43.6% for depression. Such problems were consistently more prevalent among females, poor-quality sleepers, students with food insecurity and those with insufficient social support.

CONCLUSIONS

Significant burden of problems related to psychological symptoms exists within the postsecondary student population and varies by student characteristics.

Circadian preference and mental health outcomes in youth: A systematic review and meta-analysis

Youth is a vulnerable developmental period associated with an increased preference for eveningness and risk for developing psychopathology. Growing evidence suggests a link between eveningness and poorer mental health outcomes, but the findings in the current literature are inconsistent, and a comprehensive synthesis of evidence in this area remains lacking. This meta-analysis aimed to 1) synthesise the existing evidence on the association between circadian preference and mental health outcomes in youths and 2) explore potential sleep-related factors that may moderate the relationship between circadian preference and mental health outcomes. A systematic search of five electronic databases resulted in 81 observational studies included in the review. Eveningness was found to be significantly associated with general mental health (r = 0.20), mood-related disturbances (r = 0.17), and anxiety problems (r = 0.13). The qualitative review also identified that eveningness was associated with greater risks for psychotic symptoms and maladaptive eating behaviours. These findings highlighted the need to consider circadian preference in the clinical management of youth mental health problems. Further research is needed to examine the efficacy of a circadian-focused intervention in the context of youth mental health.

Implicit and Explicit Stigma of Chronotype in Emerging Adults

BACKGROUND

Individuals with poor sleep (e.g., insomnia) and mental health (e.g., depression) experience negative stigma but no studies have examined the relationship between stigma and evening chronotype. The present mixed methods study aimed to assess and describe explicit and implicit attitudes about evening and morning chronotypes in a sample of emerging adults.

PARTICIPANTS

49 undergraduates (M_age = 19.9 [SD = 1.5], 83.7% female).

METHODS

Participants completed self-reports of demographics and chronotype. Attitudes about "night owls" and "early birds" were measured with self-report questionnaires (explicit attitudes) and an Implicit Association Task (implicit attitudes). Participants described associations with evening and morning chronotypes in free-text responses, which were qualitatively coded.

RESULTS

We found evidence of implicit bias against night owls and for early birds. The positive mean implicit d score was 0.57 (SD = 0.47), indicating a moderate implicit bias for pairing "bad" with "night owl" and "good" with "early bird." No baseline characteristics, including chronotype, were significantly associated with implicit bias. Analyses of explicit bias revealed participants perceived night owls as significantly more lazy, unhealthy, undisciplined, immature, creative, and young. Analysis of free-text responses provided further evidence of these associations.

CONCLUSIONS

Consistent with hypothesis, undergraduates demonstrated predominantly negative implicit and explicit stigma toward evening chronotypes compared to morning types. As stigma can lead to adverse consequences, future studies should assess the impact of negative societal and self-stigma on evening types. Consideration of societal stigma within clinical intervention contexts could have the potential to reduce shame or other emotions that interfere with sleep.

Circadian preference in young adults: Associations with sleep and mental health outcomes from a national survey of Norwegian university students

Individual preferred timing of sleep and activity patterns, known as circadian preference, ranges from definitely morning types to definitely evening types. Being an evening type has been linked to adverse sleep and mental health outcomes. This study aimed to explore the associations between circadian preference and self-reported sleep, depression, anxiety, quality of life, loneliness, and self-harm/suicidal thoughts. Data stem from a national survey of students in higher education in Norway (the SHoT-study). All 169,572 students in Norway were invited to participate, and 59,554 students (66.5% women) accepted (response rate = 35.1%). Circadian preference was associated with sleep and mental health outcomes in a dose-response manner. For both genders, being an evening type (either definitely evening or more evening than morning) was associated with an increase in age-adjusted relative risk (RR-adjusted; range = 1.44 to 2.52 vs. 1.15 to 1.90, respectively) across all outcomes compared with definitely morning types. Overall, the present study provides further evidence that evening circadian preference is associated with adverse sleep and mental health outcomes in young adults. As such, future efforts to improve sleep and mental health in young adults should consider their circadian preferences.

Morningness-eveningness preference and shift in chronotype during COVID-19 as predictors of mood and well-being in university students

It is suggested that social obligations, such as early work/school starts, have a disadvantageous impact on sleep behavior that can further transfer to mental health problems. Lockdown as a result of the COVID-19 pandemic created a unique opportunity to research human sleep-wake behavior in naturalistic conditions of decreased social obligations. This study aimed to test whether a change in habitual sleep-wake timing (shift in chronotype) during the COVID-19 lockdown impacted mood and well-being, and whether the impact differs according to morningness-eveningness preference. University students (N = 1011; Mean_age = 21.95 ± 1.95 years) filled out self-report questionnaires containing measures of chronotype (midpoint of sleep) before and during the COVID-19 lockdown, morningness-eveningness preference, mood, and well-being. The impact of morningness-eveningness preference and shift in chronotype was tested via multiple regression analyses. Results showed that participants shifted their chronotype in line with their morningness-eveningness preference, and that shift toward earlier sleep-wake timing was related to better moods and well-being. Moreover, higher levels of positive mood (vigor) and well-being were found in individuals who shifted their sleep-wake timing earlier and were higher on morningness.

Circadian typology is related to emotion regulation, metacognitive beliefs and assertiveness in healthy adults

Circadian typology has been related to several mental health aspects such as resilience, perceived well-being, emotional intelligence and psychological symptoms and disorders. However, the relationship between circadian typology and emotion regulation, metacognitions and assertiveness, which constitute core constructs related to psychological well-being and psychopathology, remain unexplored. This study aims to analyze whether circadian typology is related with those three constructs, considering the possible influence of sex. 2283 participants (833 women), aged 18–60 years (30.37 ± 9.26 years), completed the reduced Morningness-Eveningness Questionnaire, the Emotion Regulation Questionnaire, the Meta-Cognitions Questionnaire 30, and the Rathus Assertiveness Schedule. Main effects were observed between circadian typology and cognitive reappraisal, metacognitions, negative beliefs of uncontrollability and danger, cognitive confidence, cognitive self-consciousness, and assertiveness (F_(2,2276) > 4.80, p < 0.009, η_p² > 0.004, in all cases). Morning-type participants scored lower than evening-type in general metacognitive beliefs, negative beliefs of uncontrollability and danger, cognitive confidence, and cognitive self-consciousness, and higher than evening-type in cognitive reappraisal and assertiveness, while neither-type exhibited intermediate scores (p < 0.033 in all cases). According to the results, evening-type individuals might display a higher tendency to support maladaptive beliefs about thinking itself as well as a lesser tendency to reappraise a potentially emotion eliciting situations in order to modify its meaning and its emotional impact and to exert their rights respectfully. This new evidence improves the understanding of the relationships between circadian typology and psychological factors related to psychological well-being and psychopathology. Results implications for the onset and maintenance of psychological problems are discussed. Although future longitudinal studies are needed, results emphasize evening-type as a risk factor for the development of psychological disturbances and morning-type as a protective factor against those.