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Güleç A, Güler HA, Türkoğlu S. Relationship between Traumatic Experiences, Circadian Preference and ADHD Symptoms in Adolescents with ADHD Residing in Institutional Care: A Controlled Study. Chronobiol Int 2024; 41:495-503. [PMID: 38375810 DOI: 10.1080/07420528.2024.2319218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/09/2024] [Indexed: 02/21/2024]
Abstract
Circadian preference, describes biological and behavioural characteristics that influence the ability to plan daily activities according to optimal waking times. It is divided into three main categories: morning, evening and intermediate. In particular, the evening chronotype is associated with conditions such as Attention Deficit Hyperactivity Disorder (ADHD) and Post Traumatic Stress Disorder (PTSD). This study was conducted in three groups aged 14-18 years: The first group consisted of 34 adolescents diagnosed with ADHD who had been in institutional care for at least two years and had not used medication in the last six months. The second group included 29 adolescents with ADHD living with their families who had not used medication in the last six months. The third control group consisted of 32 healthy adolescents. The study utilized sociodemographic data forms, the Turgay DSM-IV Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S) to measure ADHD symptoms, the Childhood Chronotype Questionnaire (CCQ), and the Childhood Trauma Questionnaire (CTQ). In institutionalized adolescents with diagnosed ADHD, ADHD and disruptive behavior symptoms were more severe. Increased trauma scores were associated with higher ADHD and disruptive behaviour symptom severity and evening chronotype. In the conducted mediation analysis, evening chronotype was identified as a full mediator in the relationship between trauma symptoms and ADHD symptoms, while it was determined as a partial mediator in the relationship between trauma symptoms and PTSD symptoms. In conclusion, traumatic experiences in institutionalized adolescents with diagnosed ADHD may exacerbate ADHD and disruptive behavior symptoms. Evening chronotype is associated with ADHD and disruptive behavior symptoms, and therefore, the chronotypes of these adolescents should be assessed. Chronotherapeutic interventions may assist in reducing inattention, hyperactivity, and behavioral problems.
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Affiliation(s)
- Ahmet Güleç
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Selçuk University, Konya, Türkiye
| | - Hasan Ali Güler
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Selçuk University, Konya, Türkiye
| | - Serhat Türkoğlu
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Selçuk University, Konya, Türkiye
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Hasler BP, Schulz CT, Pedersen SL. Sleep-Related Predictors of Risk for Alcohol Use and Related Problems in Adolescents and Young Adults. Alcohol Res 2024; 44:02. [PMID: 38500552 PMCID: PMC10948113 DOI: 10.35946/arcr.v44.1.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
PURPOSE Growing evidence supports sleep and circadian rhythms as influencing alcohol use and the course of alcohol use disorder (AUD). Studying sleep/circadian-alcohol associations during adolescence and young adulthood may be valuable for identifying sleep/circadian-related approaches to preventing and/or treating AUD. This paper reviews current evidence for prospective associations between sleep/circadian factors and alcohol involvement during adolescence and young adulthood with an emphasis on the effects of sleep/circadian factors on alcohol use. SEARCH METHODS The authors conducted a literature search in PsycInfo, PubMed, and Web of Science using the search terms "sleep" and "alcohol" paired with "adolescent" or "adolescence" or "young adult" or "emerging adult," focusing on the title/abstract fields, and restricting to English-language articles. Next, the search was narrowed to articles with a prospective/longitudinal or experimental design, a sleep-related measure as a predictor, an alcohol-related measure as an outcome, and confirming a primarily adolescent and/or young adult sample. This step was completed by a joint review of candidate article abstracts by two of the authors. SEARCH RESULTS The initial search resulted in 720 articles. After review of the abstracts, the list was narrowed to 27 articles reporting on observational longitudinal studies and three articles reporting on intervention trials. Noted for potential inclusion were 35 additional articles that reported on studies with alcohol-related predictors and sleep-related outcomes, and/or reported on candidate moderators or mediators of sleep-alcohol associations. Additional articles were identified via review of relevant article reference lists and prior exposure based on the authors' previous work in this area. DISCUSSION AND CONCLUSIONS Overall, the review supports a range of sleep/circadian characteristics during adolescence and young adulthood predicting the development of alcohol use and/or alcohol-related problems. Although sleep treatment studies in adolescents and young adults engaging in regular and/or heavy drinking show that sleep can be improved in those individuals, as well as potentially reducing alcohol craving and alcohol-related consequences, no studies in any age group have yet demonstrated that improving sleep reduces drinking behavior. Notable limitations include relatively few longitudinal studies and only two experimental studies, insufficient consideration of different assessment timescales (e.g., day-to-day vs. years), insufficient consideration of the multidimensional nature of sleep, a paucity of objective measures of sleep and circadian rhythms, and insufficient consideration of how demographic variables may influence sleep/circadian-alcohol associations. Examining such moderators, particularly those related to minoritized identities, as well as further investigation of putative mechanistic pathways linking sleep/circadian characteristics to alcohol outcomes, are important next steps.
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Affiliation(s)
- Brant P Hasler
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Christina T Schulz
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sarah L Pedersen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Yu Y, Feng Y, Xu S, Wilson A, Chen C, Ling X, Chen R, Wang Y. The influence of childhood trauma and chronotype on suicide attempts in Chinese emerging adults with severe depressive symptoms. BMC Psychol 2024; 12:12. [PMID: 38173011 PMCID: PMC10765889 DOI: 10.1186/s40359-023-01472-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 11/29/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Studies have investigated how adults with severe depressive symptoms are more likely to attempt suicide, and these adults often have traumatic experiences and chaotic sleep/wake rhythms. Thus, this study using Latent class analysis aimed to investigate the relationship between childhood trauma class, chronotype, and suicide attempts among emerging adults with severe depressive symptoms. METHODS This study was conducted among emerging adults with severe depressive symptoms covering 63 Universities in Jilin Province, China. A total of 1,225 emerging adults (mean age = 19.6 ± 1.78) constructed the final sample. In addition to measuring socio-demographic characteristics, the Childhood Trauma Questionnaire-Short Form, the Single-Item Chronotyping, and a single item for suicide attempts were used to evaluate childhood trauma, chronotype, and suicide attempts, respectively. Latent class analysis was applied to identify the classes of childhood trauma within emerging adults who had severe depressive symptoms. Hierarchical logistic regression models were run to investigate the effects of socio-demographic characteristics, chronotype, and childhood trauma class on suicide attempts. RESULTS Three latent classes were identified: the Low-risk for childhood trauma class, the Neglect class, and the High-risk for childhood abuse class. Those who suffered sexual, emotional, and physical abuse at the same time were divided into the High-risk for childhood abuse class, and were significantly more likely to experience suicide attempts than those in the Neglect class (OR = 1.97, 95%CI = 1.34-2.89, p < 0.001) and the Low-risk for childhood trauma class (OR = 2.28, 95% CI = 1.50-3.46, p < 0.001). In terms of chronotype, the results showed that the chaotic type was a risk factor for suicide attempts when compared with the evening type (OR = 0.46, 95%CI = 0.27-0.78, p < 0.01), the moderately active type (OR = 0.53, 95%CI = 0.31-0.89, p < 0.05), and the daytime type (OR = 0.42, 95%CI = 0.21-0.86, p < 0.05). Overall, the significant risk factors for suicide attempts included being female, living in an urban area, having experienced sexual, emotional, and physical abuse simultaneously, and having a chaotic chronotype. CONCLUSION Emerging adults suffering sexual, emotional, and physical abuse at the same time and identifying with chaotic chronotype showed a higher risk of attempting suicide. The findings provided a clinical reference to quickly identify those at high risk of suicide attempts among emerging adults with severe depressive symptoms.
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Affiliation(s)
- Yi Yu
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Yi Feng
- Mental Health Center, Central University of Finance and Economics, Beijing, China
- Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Shicun Xu
- Northeast Asian Research Center, Jilin University, Changchun, China
- Department of Population, Resources and Environment, Northeast Asian Studies College, Jilin University, Changchun, China
- China Center for Aging Studies and Social-Economic Development, Jilin University, Changchun, China
| | - Amanda Wilson
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Chang Chen
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Xi Ling
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Runsen Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Yuanyuan Wang
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China.
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Sirtoli R, Mata GDG, Rodrigues R, Martinez-Vizcaíno V, López-Gil JF, Guidoni CM, Mesas AE. Is evening chronotype associated with higher alcohol consumption? A systematic review and meta-analysis. Chronobiol Int 2023; 40:1467-1479. [PMID: 37974373 DOI: 10.1080/07420528.2023.2256899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 09/02/2023] [Indexed: 11/19/2023]
Abstract
A broader understanding of whether and to what extent chronotype should be considered a risk factor for alcohol consumption is needed. The aim of this systematic review was to summarize the evidence on the association between evening chronotype and alcohol consumption. A systematic search of observational studies on this association was conducted in the PubMed, Scopus, Web of Science, Cochrane Library and PsycINFO databases up to April 30th, 2023. Random-effect models estimated the pooled odds ratio (OR) of alcohol consumption according to chronotype. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Quality Assessment tool for Observational Cohorts and Cross-sectional Studies from the National Heart, Lung and Blood Institute were followed. A total of 33 studies involving 28 207 individuals (age range: 18-93 years) were included in this review. Overall, most studies indicated a higher volume and frequency of alcohol consumption in evening-type individuals than in individuals with different chronotypes. Additionally, a meta-analysis including 13 studies showed that evening-type individuals were 41% more likely to consume alcohol than those with other chronotypes (OR = 1.41, 95% confidence interval: 1.16-1.66; I2 = 38.0%). Limitations of the present findings are the predominance of cross-sectional studies and varied definitions of alcohol consumption. The available evidence supports an association between the evening chronotype and alcohol consumption. The evening-type population, especially young adults, is a specific target for educational interventions for preventing or reducing alcohol consumption.PROSPERO number: CRD42022343778.
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Affiliation(s)
- Rafaela Sirtoli
- Postgraduate Program in Public Health, Universidade Estadual de Londrina, Londrina, Brazil
| | | | - Renne Rodrigues
- Postgraduate Program in Public Health, Universidade Estadual de Londrina, Londrina, Brazil
- Department of Public Health, Universidade Estadual de Londrina, Londrina, Brazil
| | - Vicente Martinez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - José Francisco López-Gil
- Navarrabiomed, Hospital Universitario de Navarra, Universidad Pública de Navarra, IdiSNA, Pamplona, Spain
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- One Health Research Group, Universidad de Las Américas, Quito, Ecuador
| | - Camilo Molino Guidoni
- Postgraduate Program in Public Health, Universidade Estadual de Londrina, Londrina, Brazil
- Department of Pharmaceutical Sciences, Universidade Estadual de Londrina, Londrina, Brazil
| | - Arthur Eumann Mesas
- Postgraduate Program in Public Health, Universidade Estadual de Londrina, Londrina, Brazil
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
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McCarthy MJ, Brumback T, Thomas ML, Meruelo AD. The relations between chronotype, stressful life events, and impulsivity in the Adolescent Brain Cognitive Development (ABCD) study. J Psychiatr Res 2023; 167:119-124. [PMID: 37866325 DOI: 10.1016/j.jpsychires.2023.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 10/04/2023] [Accepted: 10/14/2023] [Indexed: 10/24/2023]
Abstract
Circadian rhythm disturbances, especially circadian phase delays are associated with impulsive behaviors and have been implicated in psychiatric disorders. Chronotype is a developmentally regulated proxy measure of circadian phase. Past studies have investigated the relationship between chronotype and trauma and found that trauma is associated with evening chronotypes, suggesting the course of chronotype development may be affected by adverse childhood experiences (ACEs). However, the relationships among chronotype, impulsivity and ACEs have largely been studied in a pairwise manner using small, cross-sectional cohorts. We hypothesized that in a cohort of high-risk youth, childhood trauma would be associated with later chronotype, and later chronotype would be associated with higher rates of impulsivity. We analyzed a cross-sectional sample (n = 966) from Year 2 of adolescents at high risk for psychiatric disorders from the ABCD study who were characterized for chronotype, stressful life events, and impulsivity. We used a hierarchical regression model to examine the relationship between chronotype, stressful life events, and impulsivity using the Munich Chronotype Questionnaire (MCTQ), the Life Events Scale, Urgency, Premeditation, Perseverance and Sensation Seeking (UPPS) Impulsive Behavior scale. We found associations between eveningness, stressful life events, and all dimensions of impulsivity. Increased eveningness was associated with a higher number of stressful life events and increased impulsivity. Understanding the role of stressful life events and impulsivity in those predisposed towards eveningness is useful because it may improve our understanding of the biological mechanisms that contribute to psychiatric disorders, and lead to better prevention and treatment efforts using interventions such as increased lifestyle regularity and daytime light exposure.
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Affiliation(s)
- Michael J McCarthy
- University of California, San Diego, VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA.
| | - Ty Brumback
- Northern Kentucky University, 1 Louie B Nunn Dr, Highland Heights, KY, 41099, USA.
| | - Michael L Thomas
- Colorado State University, 1876 Campus Delivery, Fort Collins, CO, 80523-1876, USA.
| | - Alejandro D Meruelo
- University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
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Hublin C, Kaprio J. Chronotype and mortality - a 37-year follow-up study in Finnish adults. Chronobiol Int 2023; 40:841-849. [PMID: 37322846 DOI: 10.1080/07420528.2023.2215342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 05/03/2023] [Accepted: 05/12/2023] [Indexed: 06/17/2023]
Abstract
The UK Biobank study on chronotype and mortality suggested small increases of all-cause and cardiovascular mortality in a 6.5-year follow-up. Our aim was to constructively replicate findings from it in a longer follow-up. A questionnaire was administered to the population-based adult Finnish Twin Cohort in 1981 (response rate 84%). The study population included 23 854 participants who replied to the question: "Try to assess to what extent you are a morning person or an evening person," with four response alternatives (anchored from "clearly a morning person" to "clearly an evening person"). Vital status and cause of death data were provided by nationwide registers up to the end of 2018. Hazard ratios for mortality were computed based on 8728 deaths. Adjustments were made for education, alcohol, smoking, BMI, and sleep duration. The covariate adjusted model showed a 9% increase of all-cause mortality for the evening-type group (HR = 1.09, 95% CI 1.01-1.18), with attenuation mainly due to smoking and alcohol. Their importance was highlighted by observing no increased mortality among non-smokers who were at most light drinkers. There was no increase in any cause-specific mortality. Our results suggest that there is little or no independent contribution of chronotype to mortality.
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Affiliation(s)
- Christer Hublin
- Working Ability and Working Careers, Finnish Institute of Occupational Health, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jaakko Kaprio
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
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7
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Zhang Y, Jin Z, Li S, Xu H, Wan Y, Tao F. Relationship between chronotype and mental behavioural health among adolescents: a cross-sectional study based on the social ecological system. BMC Psychiatry 2023; 23:404. [PMID: 37280607 DOI: 10.1186/s12888-023-04879-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 05/16/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Health risk behaviors (HRBs) is a kind of phenomenon behavior that often occurs in adolescence, and also often appears in clusters. Previous studies suggested an association between social ecological risk factors (SERFs) and HRBs. This study explored 1) whether chronotype moderates the risk of HRBs associated with SERFs and 2) whether mental health is a mediator in this relationship. METHODS Adolescents were recruited from 39 junior or senior schools (three cities, 13 schools per city) using a multistage cluster sampling method conducted between October, 2020 and June, 2021. The Social Ecological System, Morningness-Eveningness Questionnaire, Brief Instrument on Psychological Health Youths, and Youth Risk Behavior Surveillance questionnaires were used to measure the SERFs, chronotype, mental health and HRBs. Latent category analysis was used to explore the clustering mode of HRBs. The primary exposure was SERFs, and the primary outcome was HRBs; chronotype was a moderator, and mental health was a mediator. The multivariable logistic regression model was used to determine the relationship between SERFs and chronotype and mental behavioral health status. Mediation moderate analysis using the PROCESS method was used to explore the relationship between these variables. Sensitivity analysis was conducted to evaluate the robustness of the model. RESULTS In total, 17,800 individuals were initially enrolled. After excluding 947 individuals with invalid questionnaires, 16,853 participants were finally included in the analysis. The mean age of participants was 15.33 ± 1.08 years. After adjusting for covariates, multivariable logistic regression found that high levels of SERFs (odds ratio [OR] = 10.10, 95% confidence interval [CI]: 8.88-11.43, P < 0.01), intermediate chronotype (OR = 5.24, 95% CI: 4.57-6.01, P < 0.01), and eveningness (OR = 1.83, 95% CI: 1.64-2.05, P < 0.01) were associated with higher HRBs frequency. This study also assessed the interaction between chronotype, SERFs and HRBs (OR = 27.84, 95% CI: 22.03-35.19, P < 0.01) and mental health (OR = 18.46, 95% CI: 13.16-25.88, P < 0.01). The moderated mediation analyses examined the relationship between chronotype, SERFs, mental health and HRBs. CONCLUSIONS SERFs may be important variables in measuring the effect of the adolescent psychosocial environment on HRBs; this effect is mediated by mental health and moderated by chronotype.
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Affiliation(s)
- Yi Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China
- MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Zhengge Jin
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China
- MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Shuqin Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China
- MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Huiqiong Xu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China
- MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Yuhui Wan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China.
- MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, 230032, Anhui, China.
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.
- NHC Key Laboratory of Study On Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China.
- MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, 230032, Anhui, China.
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Mason SL, Junges L, Woldman W, Facer-Childs ER, de Campos BM, Bagshaw AP, Terry JR. Classification of human chronotype based on fMRI network-based statistics. Front Neurosci 2023; 17:1147219. [PMID: 37342462 PMCID: PMC10277557 DOI: 10.3389/fnins.2023.1147219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/17/2023] [Indexed: 06/23/2023] Open
Abstract
Chronotype-the relationship between the internal circadian physiology of an individual and the external 24-h light-dark cycle-is increasingly implicated in mental health and cognition. Individuals presenting with a late chronotype have an increased likelihood of developing depression, and can display reduced cognitive performance during the societal 9-5 day. However, the interplay between physiological rhythms and the brain networks that underpin cognition and mental health is not well-understood. To address this issue, we use rs-fMRI collected from 16 people with an early chronotype and 22 people with a late chronotype over three scanning sessions. We develop a classification framework utilizing the Network Based-Statistic methodology, to understand if differentiable information about chronotype is embedded in functional brain networks and how this changes throughout the day. We find evidence of subnetworks throughout the day that differ between extreme chronotypes such that high accuracy can occur, describe rigorous threshold criteria for achieving 97.3% accuracy in the Evening and investigate how the same conditions hinder accuracy for other scanning sessions. Revealing differences in functional brain networks based on extreme chronotype suggests future avenues of research that may ultimately better characterize the relationship between internal physiology, external perturbations, brain networks, and disease.
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Affiliation(s)
- Sophie L. Mason
- School of Mathematics, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Systems Modelling and Quantitative Biomedicine, University of Birmingham, Birmingham, United Kingdom
| | - Leandro Junges
- Centre for Systems Modelling and Quantitative Biomedicine, University of Birmingham, Birmingham, United Kingdom
| | - Wessel Woldman
- Centre for Systems Modelling and Quantitative Biomedicine, University of Birmingham, Birmingham, United Kingdom
| | - Elise R. Facer-Childs
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Danny Frawley Centre for Health and Wellbeing, Melbourne, VIC, Australia
- Centre for Human Brain Health, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
- Faculty of Health and Medical Sciences, University of Surrey, Surrey, United Kingdom
| | | | - Andrew P. Bagshaw
- Centre for Human Brain Health, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - John R. Terry
- Centre for Systems Modelling and Quantitative Biomedicine, University of Birmingham, Birmingham, United Kingdom
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Meneo D, Bacaro V, Curati S, Russo PM, Martoni M, Gelfo F, Baglioni C. A systematic review and meta-analysis of the association between young adults' sleep habits and substance use, with a focus on self-medication behaviours. Sleep Med Rev 2023; 70:101792. [PMID: 37269785 DOI: 10.1016/j.smrv.2023.101792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 06/05/2023]
Abstract
Young adults (18-30 years) are vulnerable to sleep-wake disturbances and substance use, which are bi-directionally associated. The present work aims to organise the literature that deals with the association between sleep and substance use in young adults, also considering self-medication behaviours. We adopted a framework that accounts for the multidimensionality of sleep and the effect of different substances. We considered sleep disturbances (insomnia symptoms, sleep quality), sleep health dimensions (duration, satisfaction, efficiency, timing, daytime alertness), circadian characteristics (chronotype). Substances were alcohol, caffeine, nicotine, cannabis, others. We included 46 studies. The use of caffeine and nicotine was associated with higher odds of sleep disturbances. No significant effect was detected for sleep duration. In narrative findings, daytime dysfunction was associated with alcohol and caffeine use, and poor sleep satisfaction with nicotine use. Few evidence were available for the other sleep health dimensions. Evening chronotype was associated with alcohol, caffeine, and nicotine use. Few studies focused on cannabis or self-medication. Longitudinal results were inconclusive. We found a distinct pattern of associations between different substances and different sleep outcomes. Further investigation considering the multidimensionality of sleep would create a better understanding of the complex relationship between substance use and sleep health in young adults.
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Affiliation(s)
- Debora Meneo
- Department of Human Sciences, Guglielmo Marconi University, Rome, Italy.
| | - Valeria Bacaro
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Sara Curati
- Department of Human Sciences, Guglielmo Marconi University, Rome, Italy
| | - Paolo Maria Russo
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Monica Martoni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Francesca Gelfo
- Department of Human Sciences, Guglielmo Marconi University, Rome, Italy; IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Chiara Baglioni
- Department of Human Sciences, Guglielmo Marconi University, Rome, Italy; Department of Clinical Psychology and Psychophysiology/Sleep, Medicine, Centre for Mental Disorders, University Medical Centre, Freiburg, Germany
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Garbazza C, Hackethal S, Migliore E, D'Agostino A, Serrati C, Fanti V, Riccardi S, Baiardi S, Cicolin A, Borgwardt S, Mondini S, Cirignotta F, Cajochen C, Manconi M. Influence of chronotype on the incidence and severity of perinatal depression in the "Life-ON" study. J Affect Disord 2022; 317:245-255. [PMID: 36055526 DOI: 10.1016/j.jad.2022.08.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 05/10/2022] [Accepted: 08/21/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Perinatal depression (PND) is a severe complication of pregnancy, but there are no established risk factors predicting the disease. Evening chronotype has been associated with unhealthy lifestyle habits and adverse outcomes during pregnancy. In this study, we aimed to clarify whether chronotype can predict symptoms and/or occurrence of PND. METHODS Two hundred ninety-nine women were followed-up from the first trimester of pregnancy until 6 months postpartum. Chronotype was assessed at baseline using the MEQ, while mood was repeatedly assessed by depression rating scales (EPDS, HDRS, MADRS). The influence of time and chronotype on EPDS, HDRS and MADRS, was estimated by constructing multilevel linear mixed regression models. A Cox proportional-hazard regression model was built to evaluate the association between chronotype and incidence of depression. RESULTS Chronotype modulated PND symptom severity depending on time of assessment, with evening chronotypes having a higher risk for developing PND symptoms, as assessed by EPDS, at postpartum visits V4 (5-12 days) and V5 (19-26 days). These also had less healthy lifestyle habits and were more likely to suffer from gestational diabetes mellitus and undergo cesarean delivery as compared to other chronotypes. LIMITATIONS Only a minority of women were classified as evening chronotypes. The long follow-up phase of the study led to missing data. CONCLUSIONS Pregnant evening chronotypes show unhealthy lifestyle habits and sociodemographic characteristics commonly associated with a higher risk for PND. They also have a higher risk of developing PND symptoms in the first month after delivery. Chronotype should therefore be routinely assessed during pregnancy to identify women potentially at risk for developing PND.
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Affiliation(s)
- Corrado Garbazza
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland; Centre for Chronobiology, University of Basel, Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland.
| | - Sandra Hackethal
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | - Enrica Migliore
- Clinical Epidemiology Unit, University Hospital Città Della Salute e Della Scienza di Torino, Turin, Italy; Cancer Epidemiology Unit, University Hospital Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Armando D'Agostino
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy; Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Chiara Serrati
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy; Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Valentina Fanti
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy; Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Silvia Riccardi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | - Simone Baiardi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Department of Experimental, Diagnostics, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Alessandro Cicolin
- Sleep Medicine Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Stefan Borgwardt
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland; Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Susanna Mondini
- Neurology Unit, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | | | - Christian Cajochen
- Centre for Chronobiology, University of Basel, Basel, Switzerland; Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
| | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
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11
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Işik M, Kirli U. The mediating effect of attachment insecurity on circadian consequences of childhood trauma. Chronobiol Int 2022; 39:936-947. [PMID: 35300548 DOI: 10.1080/07420528.2022.2050385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Circadian preferences have been associated with mental health as well as social and physical health in recent years. However, factors associated with circadian preferences have not been fully elucidated. The main aim of this study is to investigate the associations of childhood trauma and attachment styles with circadian preferences. A total of 673 participants were evaluated using the Morningness-Eveningness Questionnaire (MEQ), the Childhood Trauma Questionnaire 28 (CTQ-28), and the Experiences in Close Relationships-Revised (ECR-R) questionnaire. The results indicated that 14.9% (n = 100) of the participants were morning type, 20.6% (n = 139) were evening type, and 64.5% (n = 434) were intermediate type. Both childhood trauma and attachment-related anxiety/avoidance scores were associated with being evening type (p < .01). Moreover, attachment-related anxiety and avoidance fully mediated the association between childhood trauma and circadian preferences. The present study showed that attachment styles might be associated with circadian preferences. Further studies are needed to replicate these results and to infer explanatory mechanisms for these cross-sectional associations.
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Affiliation(s)
- Mesut Işik
- Faculty of Medicine, Department of Psychiatry, Van Yuzuncu Yil University, Van, Turkey
| | - Umut Kirli
- Department of Drug Abuse, Ege University, Institute on Drug Abuse, Toxicology and Pharmaceutical Science, Izmir, Turkey
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12
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Fernando J, Stochl J, Ersche KD. Drug Use in Night Owls May Increase the Risk for Mental Health Problems. Front Neurosci 2022; 15:819566. [PMID: 35087376 PMCID: PMC8787192 DOI: 10.3389/fnins.2021.819566] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 12/21/2021] [Indexed: 12/12/2022] Open
Abstract
Drugs of abuse are widely known to worsen mental health problems, but this relationship may not be a simple causational one. Whether or not a person is susceptible to the negative effects of drugs of abuse may not only be determined by their addictive properties, but also the users’ chronotype, which determines their daily activity patterns. The present study investigates the relationship between chronotype, drug use and mental health problems in a cross-sectional community sample. Participants (n = 209) completed a selection of questionnaires online, including the Munich Chronotype Questionnaire, the Depression Anxiety Stress Scale, the Alcohol Use Disorder Identification Test, the Cannabis Use Disorder Identification Test and the Fagerström Test for Nicotine Dependence. We conducted multiple regression models to determine relationships between participants’ chronotype and their reported mental health symptoms and then estimated mediation models to investigate the extent to which their drug consumption accounted for the identified associations. Chronotype was significantly associated with participants’ overall mental health (β = 0.16, p = 0.022) and their anxiety levels (β = 0.18, p = 0.009) but not with levels of depression or stress. However, both relationships were fully mediated by participants’ overall drug consumption. Thus, late chronotypes, so-called “night owls”, not only use more drugs but consequently have an increased risk for developing anxiety and deteriorating mental health status. This group may be particularly vulnerable to the negative psychological effects of drugs. Our results point toward the importance of considering chronotype in designing preventative and therapeutic innovations, specifically for anxiety, which at present has been largely neglected.
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Affiliation(s)
- Jeevan Fernando
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Department of Kinanthropology and Humanities, Charles University, Prague, Czechia
| | - Karen D. Ersche
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- *Correspondence: Karen D. Ersche,
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13
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Lan A, Kotler D, Kronfeld-Schor N, Stukalin Y, Einat H. Changes in sleep patterns of college students in Israel during COVID-19 lockdown, a sleep diaries study. Sleep Biol Rhythms 2022; 20:309-314. [PMID: 35035287 PMCID: PMC8744381 DOI: 10.1007/s41105-021-00371-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 12/30/2021] [Indexed: 01/08/2023]
Abstract
To prevent and reduce the spread of COVID-19, governments around the world apply social restrictions and lockdowns. Such lockdowns significantly alter daily routine and habits. A growing body of research indicates that lockdowns affect sleep and circadian rhythms. The current study further explores this effect using sleep logs for a relatively long duration including lockdown and post-lockdown periods in Israel. For two consecutive months, both during lockdown and during post-lockdown periods, from March 13th, 2020 to May 12th, 2020, Israeli students were asked to fill out daily sleep logs in which they report their sleep and wake times. The participants were also asked to fill out the Morningness–Eveningness Questionnaire (MEQ) in the beginning of the study. Data show increase in sleep duration and a delayed midsleep point during lockdown, compared to post-lockdown periods, both on workdays and on weekends. An interaction between chronotype and lockdown was also observed; morning types sleep more both during lockdown and during post-lockdown periods. Interestingly, the midsleep point of late chronotypes is later during both workdays and weekends even during lockdown when social constrains on sleep time are in part removed. Overall, the current results based on detailed and relatively long-term sleep logs analysis confirm previous work using limited measures, such as one-time questionnaires. A lockdown period affects sleep–wake behavior: during lockdown people sleep duration is increased and their sleep onset is delayed. Nevertheless, the circadian preference of individuals is conserved across conditions.
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Affiliation(s)
- Anat Lan
- School of Behavioral Sciences, Tel-Aviv-Yaffo Academic College, 10 Rabenu Yeruham St., Tel-Aviv, Israel
| | - Danielle Kotler
- School of Behavioral Sciences, Tel-Aviv-Yaffo Academic College, 10 Rabenu Yeruham St., Tel-Aviv, Israel
| | | | - Yelena Stukalin
- School of Behavioral Sciences, Tel-Aviv-Yaffo Academic College, 10 Rabenu Yeruham St., Tel-Aviv, Israel
| | - Haim Einat
- School of Behavioral Sciences, Tel-Aviv-Yaffo Academic College, 10 Rabenu Yeruham St., Tel-Aviv, Israel
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14
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Čulić V, Kantermann T. Acute Myocardial Infarction and Daylight Saving Time Transitions: Is There a Risk? Clocks Sleep 2021; 3:547-557. [PMID: 34842624 PMCID: PMC8628759 DOI: 10.3390/clockssleep3040039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/18/2021] [Accepted: 10/12/2021] [Indexed: 01/16/2023] Open
Abstract
Available evidence on the risk of acute myocardial infarction (AMI) in the days after the spring daylight saving time (DST) transition suggests either a modest increase or no risk increase. Partial sleep deprivation and enhanced circadian clock misalignment have been implicated as the underlying mechanisms for increased AMI risk, probably via enhanced thrombo-inflammatory processes and activation of the sympathetic nervous system. Most of the studies, as we suggest as a perspective here, have used potentially inappropriate control periods, including the two post-transitional weeks, because adjustment after the spring DST transition lasts at least four weeks for all chronotypes and probably even beyond this period for late chronotypes. The most plausible conclusions, at the moment, for the risk of AMI after the spring DST transition are: (1) the risk is increased, (2) a relatively modest risk increase could be currently underestimated or in some studies undetected, (3) late chronotypes and/or individuals with high levels of social jetlag (a proxy for circadian clock misalignment) could be more affected by the phenomenon, and (4) underlying pathophysiological mechanisms should be further explored. As a significant part of world’s population continues to be affected by the biannual clock change, the question of increased AMI risk in the post-transitional period remains an intriguing public health issue.
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Affiliation(s)
- Viktor Čulić
- Department of Cardiology and Angiology, University Hospital Center Split, 21000 Split, Croatia
- Department of Clinical Propaedeutics, University of Split School of Medicine, 21000 Split, Croatia
- Correspondence: ; Tel.: +385-21-55-72-89; Fax: +385-21-55-73-85
| | - Thomas Kantermann
- Faculty for Health and Social Affairs, University of Applied Sciences for Economics and Management (FOM), 45127 Essen, Germany;
- SynOpus, 44799 Bochum, Germany
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15
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Siudej K, Malinowska-Borowska J. Relationship between chronotype and consumption of stimulants. Chronobiol Int 2021; 38:1549-1556. [PMID: 34080490 DOI: 10.1080/07420528.2021.1935989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Consumption of some stimulants may lead to health problems. The aim of the study was to identify a potential correlation between extreme chronotypes and the tendency to use various stimulants. The preferred time of consumption was also checked, both on working and nonworking days. The study was conducted in January 2020 using the CAWI method. 306 people took part in the survey. To determine the chronotype of the surveyed people, the polish version of MEQ questionnaire (Morningness - Eveningness Questionnaire) was used. Because 178 respondents were intermediate types, 128 people participated in the second part of the study, including 68 owls and 60 larks. Activity preferences during the day of respondents were checked and compared with data about the quantity and frequency of using stimulants like coffee, energy drinks, alcohol and cigarettes. Chi-square test was used for testing relationships. The time periods for taking stimulants differed between groups and were associated with activity during the day. It has been shown that people with evening chronotype use more energy drinks (p = .009), alcohol drinks (p = .013) and cigarettes or e-cigarettes (p = .021), especially in the group of respondents aged ≥30. Social jet lag was statistically higher in the group of owls and larks; however, consumption of stimulants depended on age and chronotype, not social jet lag. People with the morning chronotype are less likely to use stimulants. Owls showed a greater and more frequent use of energy drinks, alcohol and cigarettes, especially those older than 30 years. Assessing eveningness among people aged more than 30 may be helpful in characterizing an overall risk profile.
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Affiliation(s)
- Katarzyna Siudej
- Scientific Circle at Department of Toxicology and Health Protection, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, Bytom, Poland
| | - Jolanta Malinowska-Borowska
- Department of Toxicology and Health Protection, Faculty of Health Sciences in Bytom, Medical University of Silesia in Katowice, Bytom, Poland
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16
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Senyk O, Jankowski KS, Cholii S. Ukrainian versions of the Composite Scale of Morningness and Munich Chronotype Questionnaire. BIOL RHYTHM RES 2020. [DOI: 10.1080/09291016.2020.1788807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Oksana Senyk
- Department of Psychology, Faculty of Philosophy, Ivan Franko National University of Lviv, Lviv, Ukraine
| | | | - Sofiia Cholii
- Department of Psychology, Faculty of Philosophy, Ivan Franko National University of Lviv, Lviv, Ukraine
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17
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Thapa N, Kim B, Yang JG, Park HJ, Jang M, Son HE, Kim GM, Park H. The Relationship between Chronotype, Physical Activity and the Estimated Risk of Dementia in Community-Dwelling Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3701. [PMID: 32456356 PMCID: PMC7277473 DOI: 10.3390/ijerph17103701] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 01/10/2023]
Abstract
Our study examined the association between chronotype, daily physical activity, and the estimated risk of dementia in 170 community-dwelling older adults. Chronotype was assessed with the Horne-Östberg Morningness-Eveningness Questionnaire (MEQ). Daily physical activity (of over 3 METs) was measured with a tri-axial accelerometer. The Korean version of the Mini-Mental State Examination (K-MMSE) was used to measure the estimated risk of dementia. The evening chronotype, low daily physical activity, and dementia were positively associated with each other. The participants with low physical activity alongside evening preference had 3.05 to 3.67 times higher estimated risk of developing dementia, and participants with low physical activity and morning preference had 1.95 to 2.26 times higher estimated risk than those with high physical activity and morning preference. Our study design does not infer causation. Nevertheless, our findings suggest that chronotype and daily physical activity are predictors of the risk of having dementia in older adults aged 70 years and above.
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Affiliation(s)
- Ngeemasara Thapa
- Department of Healthcare and Science, Dong-A University, Busan 49315, Korea; (N.T.); (J.-G.Y.); (H.-J.P.); (M.J.); (H.-E.S.); (G.-M.K.)
| | - Boram Kim
- Department of Neurology, Dong-A University Hospital, Busan 49201, Korea;
| | - Ja-Gyeong Yang
- Department of Healthcare and Science, Dong-A University, Busan 49315, Korea; (N.T.); (J.-G.Y.); (H.-J.P.); (M.J.); (H.-E.S.); (G.-M.K.)
| | - Hye-Jin Park
- Department of Healthcare and Science, Dong-A University, Busan 49315, Korea; (N.T.); (J.-G.Y.); (H.-J.P.); (M.J.); (H.-E.S.); (G.-M.K.)
| | - Minwoo Jang
- Department of Healthcare and Science, Dong-A University, Busan 49315, Korea; (N.T.); (J.-G.Y.); (H.-J.P.); (M.J.); (H.-E.S.); (G.-M.K.)
| | - Ha-Eun Son
- Department of Healthcare and Science, Dong-A University, Busan 49315, Korea; (N.T.); (J.-G.Y.); (H.-J.P.); (M.J.); (H.-E.S.); (G.-M.K.)
| | - Gwon-Min Kim
- Department of Healthcare and Science, Dong-A University, Busan 49315, Korea; (N.T.); (J.-G.Y.); (H.-J.P.); (M.J.); (H.-E.S.); (G.-M.K.)
| | - Hyuntae Park
- Department of Healthcare and Science, Dong-A University, Busan 49315, Korea; (N.T.); (J.-G.Y.); (H.-J.P.); (M.J.); (H.-E.S.); (G.-M.K.)
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