Psychometric properties of the Persian version of the reduced Morningness-Eveningness Questionnaire: Further evidence

Validity and Reliability of the Korean Version of Reduced Morningness-Eveningness Questionnaire: Results From a General Population-Based Sample

BACKGROUND

Chronotype refers to individual variations in diurnal preferences that manifest as everyday behaviors, including sleep patterns. Traditionally, the Horne & Östberg Morningness-Eveningness Questionnaire (MEQ), which comprises of 19 items, has been the standard for determining chronotype. However, its length makes it cumbersome for widespread application. To address this issue, the reduced MEQ (rMEQ), a concise version containing only five items from the MEQ, was developed for a more practical approach to chronotype assessment. This study aimed to evaluate the validity and reliability of Korean version of rMEQ in a sample from the general Korean population.

METHODS

The Korean version of the rMEQ comprises of items 1, 7, 10, 18, and 19 of the original MEQ. The validity of the rMEQ was assessed by correlating its scores with those of the MEQ and Munich Chronotype Questionnaire (MCTQ). Its reliability was determined by calculating internal consistency.

RESULTS

A total of 3,030 individuals participated in the study, yielding an average rMEQ score of 14.0 ± 3.4. There was a substantial positive correlation between the rMEQ and MEQ scores (r = 0.859, P < 0.001). Furthermore, the rMEQ scores were significantly negatively correlated with the midpoint of sleep on free days corrected for sleep debt as measured by the MCTQ (r = -0.388, P < 0.001), indicating a robust association with chronotype. The internal consistency of rMEQ, measured using Cronbach's alpha, was 0.609.

CONCLUSION

This study finds the Korean version of the rMEQ to be a valid and reliable instrument for assessing chronotype in the general population.

Association between chronotype, social jetlag, sleep quality, and academic burnout among nursing students: A cross-sectional study

Academic burnout in nursing students is a serious problem worldwide that results in emotional exhaustion, cynicism and low professional efficacy. The aim of the current study was to examine the association between sleep quality and circadian rhythm indicators and academic burnout among Iranian nursing students. This cross-sectional study was conducted on 325 undergraduate nursing students studying at Qazvin University of Medical Sciences between November and February 2023. Data collection was carried out using self-report questionnaires including demographic characteristics, The Pittsburgh Sleep Quality Index (PSQI), reduced-Morningness-Eveningness Questionnaire (r-MEQ), and the Maslach Burnout Inventory-Student Survey (MBI-SS). Social jetlag (SJL) was defined as the absolute value of the difference between the midpoint of sleep on free days (MSF) and the midpoint of sleep on workdays (MSW). Data were analyzed using univariate and multivariate linear regression models. About 31.4% of participants had evening chronotype and almost half of them suffered from poor sleep quality. About 47.7% of the participants had SJL ≥ 2 h. In the multivariate linear regression model, students with evening chronotype compared to morning chronotype experienced more academic burnout in emotional exhaustion, cynicism and professional efficacy. PSQI score was only correlated with emotional exhaustion and cynicism subscales. Increased SJL was a predictor on all three subscales of academic burnout. The findings suggested that evening chronotype, poor sleep quality, and high SJL were associated with increased likelihood of academic burnout in nursing students. Assessment of circadian preference and sleep quality is beneficial for timely identification and prevention of academic burnout in nursing students.

Comparison of Chronotypes and their Relationship with Academic Performance and Quality of Life in University Students

Objective  An individual's chronotype affects circadian characteristics associated with bedtime, waking, and other daily activities. It is known that academic achievement is strongly dependent on personality traits. The present study aimed to investigate the relationship regarding chronotype, quality of life, and academic performance of university students by comparing three educational fields: medicine, technology, and art. Materials and Methods  The present cross-sectional study was conducted with 400 medicine, technology, and art students enrolled at universities in Tehran between2018 and 2019, with convenience sampling from January 2020 to January 2021. The students filled out online questionnaires, including a demographics questionnaire, a quality of life assessment questionnaire (the World Health Organization Quality of Life: Brief Version, WHOQOL-BREF), the Morningness-Eveningness Questionnaire (MEQ), the Pittsburgh Sleep Quality Index (PSQI), and the Depression, Anxiety, and Stress Scale-21 items (DASS-21). The statistical analysis was performed using the IBM SPSS Statistics for Windows software, version 22.0 ( p  < 0.05). Results  A total of 400 students were enrolled in the present study, including 115 medicine, 153 technology, and 132 art students (67.3% of female and 33.7% of male subjects, with a mean age of 21.06 ± 2.063 years). In spite of the absence of significant differences among the chronotypes of the three groups, there was a significant correlation regarding the chronotypes in all groups and quality of life ( p  = 0.005). Morning-type individuals presented better quality of life and better quality of sleep ( p  < 0.001; r = 0.175). No significant associations were found involving the students' academic performance and their chronotypes ( p  > 0.05; r = 0.026). Conclusion  Considering the chronotype's effect of improving the quality of life of students and, therefore, their academic performance, more studies are essential to effectively improve the academic performance of individuals with different chronotypes.

Psychometric properties of the Turkish reduced morningness and eveningness questionnaire

The aim of this study was to examine the psychometric properties of the 5-item Turkish Reduced Morningness-Eveningness Questionnaire (rMEQ) for the first time. The study involved 875 university students in an adaptation and validation study. Participants completed the rMEQ, MEQ, Depression Anxiety Stress Scale-21 (DASS-21), Insomnia Severity Index (ISI), Barratt Impulsiveness Scale Short Form (BIS-SF), and Oxford Happiness Questionnaire Short Form (OHQ-SF). The factor structure, convergent validity, internal consistency, sensitivity, and specificity of the rMEQ were examined. The confirmatory factor analysis showed that the rMEQ had a one-dimensional structure with good fit indices (χ2/df = 2.94, CFI = 0.990, TLI = 0.979, RMSEA = 0.047, and SRMR = 0.019). There was a significantly strong correlation between rMEQ and MEQ. In addition, we found a significantly weak correlation between rMEQ and DASS-21, ISI, BIS-SF, and OHQ-SF. The internal consistency coefficients of rMEQ were Cronbach's α = 0.706 and McDonald's ω = 0.740. The sensitivity and specificity of rMEQ were 83.3%-92.7% for morning types and 86.3%-87.3% for evening types. The Turkish rMEQ has adequate psychometric properties and can be used to assess an individual's chronotype.

The association between chronotype, sleep quality and medication errors among critical care nurses

Medication administration errors could result in severe complications in critical care units. This study investigated an association between chronotype, sleep quality and medication errors among essential nurses of care in Qazvin teaching hospitals in Iran. In this multicenter, cross-sectional study, all registered nurses of critical care units of Qazvin teaching hospitals were recruited. Data were collected through anonymous questionnaires, including socio-demographic data, Morning-Evening Questionnaire (MEQ), Pittsburgh Sleep Quality Index (PSQI) and medication errors data. Data were analyzed with SPSS v.24 by using the Chi-square test, Mann-Whitney U test, and logistic regression analysis. P values less than 0.05 were considered significant. The mean age and work experience were 33.12 ± 6.74 and 9.11 ± 5.96, respectively. One hundred sixty-six nurses (96%) have been working in rotating shifts. Nurses with intermediate chronotypes were predominant (n = 122; 70.5%). The majority of nurses (68.2%) had poor sleep quality (n = 118). Logistic regression analysis showed eveningness chronotype was associated with 4.743 fold increased risk of medication error (P < 0.033). No association was found between medication error and sleep quality (p < 0.95). There was no significant relationship between chronotype and sleep quality (P < 0.257). Our study showed that nurses with eveningness chronotype make more medication errors; therefore, considering the individual circadian preference before deciding on their shift timing assignment will be an important issue in reducing nurses' medication errors and improving patient safety in critical care units.

Validity of the Persian version of the Munich ChronoType Questionnaire (MCTQIR)

PURPOSE

Currently, the most useful questionnaire for determining the chronotype is the Munich ChronoType Questionnaire (MCTQ). It determines chronotype based on sleep-wake behavior on workdays and work-free days and uses the mid-sleep time on free days (MSF), corrected for accumulated sleep debt over the work week to classify chronotype (MSFsc). Our study aimed at validating Persian version of the MCTQ.

METHODS

Participants completed the Persian version of the MCTQ, reduced Morningness-Eveningness Questionnaire (rMEQ), Epworth sleepiness scale (ESS), and demographic characteristics.

RESULTS

The study sample was comprised of 250 Iranian men and women (mean age 34 years, age range 30 to 58 years, 113 men). Results showed that there is a significant negative relationship between the components of MCTQ and rMEQ, and the strongest relationship related to the MSF index. The results also showed that MCTQ parameters were not significantly related to the ESS scale. Cut-off values of MSFsc for chronotype categories were determined by inter-quartile range (Q25% = 3.44, Q50% = 4.68, and Q75% = 5.75).

CONCLUSIONS

Like the MCTQ in other languages, the Persian version of the MCTQ is a reliable tool for assessing chronotype.

Circadian functioning and quality of life in substance use disorder patients with and without comorbid schizophrenia

Sleep disturbances are strongly linked with mental diseases such as substance use disorder (SUD) or schizophrenia (SZ) which can have a detrimental impact on quality of life (QOL), especially when both disorders are comorbid (dual disorder). In absence of studies about both circadian characteristics and QOL in patients with SUD and comorbid SZ (SUD + SZ), we examined a sample of 155 male under treatment, 75 with SUD + SZ and 80 only with SUD. Circadian functioning was evaluated by chronotype, social jet-lag and sleep quality (using the Pittsburgh Sleep Quality Index, PSQI), while the QOL was obtained by the World Health Organization's Quality of Life Questionnaire (WHOQOL)-BREF. SUD + SZ patients were more evening type than SUD, and this chronotype was linked to polydrug use in total sample and SUD + SZ group. We observed that the comorbidity did not lead to worse sleep quality in the SUD and SUD + SZ patients. QOL was poorer in SUD + SZ patients, who showed a negative association of Physical health, Psychological health and Social relationship with suicide attempts and severity of SZ. Lastly, patients with worse QOL also reported poorer sleep quality suggesting that treatment could include circadian adjustments along with a focused approach to lifestyle improvement.

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.

Temporal associations between morningness/eveningness, problematic social media use, psychological distress and daytime sleepiness: Mediated roles of sleep quality and insomnia among young adults

The extant literature has suggested relationships between an individual's chronotype (in relation to morningness/eveningness) and several outcomes, including addictive disorders, psychological distress and daytime sleepiness. Moreover, sleep quality has been proposed to be a mediator in the aforementioned relationships. Consequently, the aim of the present study was to investigate the complex relationship between morningness/eveningness, problematic social media use, psychological distress and daytime sleepiness, with the potential mediators of sleep quality and insomnia. All participants (N = 1,791 [30.1% males]; mean age = 27.2 years, SD = 10.1) completed a battery of psychometric scales, including a reduced version of the Morningness-Eveningness Questionnaire (at baseline), the Pittsburgh Sleep Quality Index and Insomnia Severity Index (1 month after baseline assessment), the Bergen Social Media Addiction Scale, the Hospital Anxiety and Depression Scale, and the Epworth Sleepiness Scale (2 months after baseline assessment). The impacts of morningness-eveningness on problematic social media use, anxiety, depression and daytime sleepiness were found in the mediation models. Furthermore, the mediated effects of insomnia and sleep quality were observed. The present study's results emphasize the importance of promoting healthy sleep habits and sleep hygiene behaviours, and that of early detection of sleep problems among individuals who have the eveningness chronotype, because this would significantly improve their health outcomes.

Morningness-eveningness in a large sample of German adolescents and adults

People differ in their sleep-wake behavior. This individual difference is conceptualized in different aspects, such as wake up times, bed times, times of peak performance, as well as in morning affect. A total of 14,987 visitors of an exhibition in the LWL State Museum of Natural History, Münster (Germany), did the survey on chronotype and gave their consent that these data can be used for a scientific study. Age groups were coded into 5-year bins. Mean age (mean ± SD) was 28.2 ± 17.5 years. There were 8075 females (54%) and 6912 males in the sample. The German version of the rMEQ (reduced Morningness-Eveningness-Questionnaire) was used for data collection. The data showed clear age effects. Younger children are more morning oriented and become rapidly evening oriented during puberty, while the more attenuated turn towards morningness occurs from the age of 20 years. Then between the ages 25 to 30 morningness-eveningness remained rather stable. Significant gender differences existed in the reproductive age, i.e., the age groups 20 to 50 (corresponding to the age 16–50 years). In other age groups, no gender differences could be detected. Seasonal effects were also found. Chronotype score was lowest during the summer months (and more evening oriented). Based on the single item analysis of the five questions of the rMEQ, we found age group differences in all items. Gender differences occurred in all items except item 1, which deals with the preferred wake-up time. Men always scored significantly lower (i.e. more evening oriented) than women except in item 2 (tiredness after awakening). Seasonal effects were only significant in item 3, which is related to preferred bed times. People showed a later bed time preference during summer. The classification of chronotypes according to the cut-off scores provided by Adan and Almirall (1991) and by using the 20/80 percentile provided identical cut-off scores (values of 11 and below for evening types and 18 and above for morning types).