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Relationship Between Depressive Mood and Chronotype in Healthy Subjects Psychiatry and Clinical Neurosciences 2009; 63: 283–290 doi:10.1111/j.1440-1819.2009.01965.x Regular Article Relationship between depressive mood and chronotype in healthy subjects Maria Paz Hidalgo, MP, MD, PhD,1* Wolnei Caumo, MD, PhD,2,3 Michele Posser, MD,4 Sônia Beatriz Coccaro, NS, PhD,5 Ana Luiza Camozzato, MD, PhD4 and Márcia Lorena Fagundes Chaves, MD, PhD6 1Department of Psychiatry, Medical School and 6Graduate Program in Internal Medicine–Behavioral Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), 2Anesthesia and Perioperative Medicine Service, Hospital de Clínicas de Porto Alegre (HCPA), UFRGS, 3Pharmacology Department, Instituto de Ciências Básicas da Saúde, UFRGS, 4Neurology Service, HCPA and 5Department of Surgical Nursing, School of Nursing, UFRGS, Porto Alegre, Brazil Aim: The endogenous circadian clock generates daily reporting more severe depressive symptoms com- variations of physiological and behavior functions pared to morning- and intermediate-chronotypes, such as the endogenous interindividual component with an odds ratio (OR) of 2.83 and 5.01, respec- (morningness/eveningness preferences). Also, mood tively. Other independent cofactors associated with a disorders are associated with a breakdown in the higher level of depressive symptoms were female organization of ultradian rhythm. Therefore, the gender (OR, 3.36), minor psychiatric disorders (OR, purpose of the present study was to assessed the asso- 3.70) and low future self-perception (OR, 3.11). ciation between chronotype and the level of depres- Younger age, however, was associated with a lower sive symptoms in a healthy sample population. level of depressive symptoms (OR, 0.97). The ques- Furthermore, the components of the depression tions in the MADRS that presented higher discrimi- scale that best discriminate the chronotypes were nate coefficients among chronotypes were those determined. related to sadness, inner tension, sleep reduction and pessimism. Methods: This cross-sectional study involved 200 volunteers, aged 18–99 years, 118 women and 82 Conclusion: Identification of an association between men. The instruments were the Montgomery–Äsberg evening typology and depressive symptoms in Depression Rating Scale (MADRS), the Morningness/ healthy samples may be useful in further investiga- Eveningness Questionnaire, the Self-Reporting tion of circadian typology and the course of depres- Questionnaire-20, and the future self-perception sive disease. questionnaire. Key words: chronobiology, chronotype, circadian Results: Logistic regression showed that subjects with rhythm, depressive mood, morningness. the eveningness chronotype had a higher chance of HE ENDOGENOUS CIRCADIAN clock generates correspond to the temporal organization of the envi- Tdaily variations of physiological and behavior ronment.1 Many biological variables, such as body functions. Biological rhythms are cyclic changes that temperature, heart rate, blood pressure and hormone levels, show a definite periodicity with a cycle length of 24 h. Psychological and behavioral variables, such *Correspondence: Maria Paz Loayza Hidalgo, MP, MD, PhD, Castro as mood, alertness, appetite and task performance, Alves, 167, sala 204, 90430-131, Porto Alegre, RS Brazil. 2 Email: [email protected] also demonstrate circadian effects. These variables Received 26 June 2007; revised 1 December 2008; accepted have been shown to be associated with individual 6 February 2009. differences in circadian rhythm. This endogenous © 2009 The Authors 283 Journal compilation © 2009 Japanese Society of Psychiatry and Neurology 284 M. P. Hidalgo et al. Psychiatry and Clinical Neurosciences 2009; 63: 283–290 interindividual component of the circadian clock toms of depression not only in depressed patients, is the circadian typology (morningness/eveningness as demonstrated in previous studies, but also in preferences). healthy people. Thus, we assessed the association Morning types are those people who consistently between chronotype and the range of depressive prefer diurnal activity, while evening types are those symptoms, controlling for the effect of potential con- who prefer nocturnal activities.3 The morningness/ founding variables. Components of the depression eveningness dimension is regulated by a complex scale that best discriminate chronotypes were also interaction among social, geographic and genetic analyzed. factors. Studies have demonstrated that increasing age and being female are associated with morningness.4 In addition, individuals who are born during autumn and short photoperiods of 8–10 h showed stronger METHODS morningness tendencies, probably as a reflection of the influence of light intensity and variation in Subjects photoperiods during early development.5 During The study protocol was approved by the Ethics constant routines, significant differences have been Committee at the institution in which the work observed between morning and evening types in the was carried out. All participants signed an informed circadian phases of body temperature and alertness. consent form. From October to November, a system- Also, it has been demonstrated that chronotype atic sample of urban census tracts was conducted. In depends on a circadian gene polymorphism. In a UK each tract a starting point was randomly selected study it was reported that a polymorphism of PER3 and interviewers searched the neighborhood visiting genes may influence the morningness/eveningness one out of every three houses. These subjects were dimension.6 The four-repeat allele was associated selected from a community that is situated in an with eveningness and delayed sleep-phase syndrome urban circumscribed geographic area that constitutes (DSPS; which may be considered an extreme form of the catchment area of the Basic Health Unit linked to eveningness) and the five-repeat allele was associated the Hospital de Clínicas de Porto Alegre, which serves with morningness; the same association with diurnal a population of approximately 6000 living nearby. preference was also found in a Brazilian population For the present study, all members of the nuclear but the five-repeat allele was associated with DSPS, family selected who met the criteria of inclusion were probably reflecting the latitude of influence.7 The assessed. The rate of participation was >98%. The impact of this phase shift on health has been debated. sample was composed of 200 volunteers, ranging Eveningness seems to be related to morbidity and in age from 18 to 99 years (mean Ϯ SD, 34.35 Ϯ especially to sleep and mood disorder.8 16.39 years). Studies have suggested that mood disorders are Exclusion criteria were shift work, self-report of associated with a breakdown in the organization of past or current history of psychiatric disorder and ultradian rhythm.9 There is a debate as to whether medical conditions, and use of drugs known to influ- depression is related to circadian rhythms. Three lines ence sleep, as well as a medical history of organic of evidence suggest that depressive disorder has a brain damage, mental retardation, not speaking circadian component: (i) improved outcomes in Portuguese and difficulty in understanding verbal individuals exposed to light treatment; (ii) associa- commands. Drug use and diagnosed disease were tion between the timing of light and phase shift; and assessed by the following questions: ‘Do you have (iii) report of a difference in NPAS2 genes, a gene any diagnosed diseases? If yes, what kind of disease?’ family involved in circadian rhythm generation, and ‘Do you use any drug(s)? If yes, what kind of between seasonal affective disorder and healthy con- drug(s)?’ Moreover, at the end of the testing the trols.9 A phase delay has also been described in affec- subject read a list of diseases that included psychiatric tive disorders. Previous studies found an association disorders, habitual snoring, apnea, and thyroid dis- between evening type and depressive symptoms in orders, among others. Then they answered a yes or restricted samples such as students and patients with no questionnaire about the diseases and their use of mood disorder.10,11 substances (benzodiazepines, antidepressants, illicit The main hypothesis under investigation was that drugs [cocaine, cannabis], tea, and caffeine). An affir- evening-type subjects present higher rates of symp- mative answer was used as an exclusion criterion. © 2009 The Authors Journal compilation © 2009 Japanese Society of Psychiatry and Neurology Psychiatry and Clinical Neurosciences 2009; 63: 283–290 Depressive mood and chronotype 285 a score above the lowest quartile were classified as Instruments high future self-perception, reflecting an optimistic All of the psychological tests used in the present view, and those with a score equal to or below the study were validated and adapted for the Brazilian lowest quartile reflected a negative future perception population. (hopelessness). The main outcome was the depressive symptoms The World Health Organization self-reporting as assessed on the Montgomery–Äsberg Depression questionnaire (SRQ-20) has been used for screening Rating Scale (MADRS).12 This scale contains 10 ques- of minor psychiatric disorders: somatic symptoms, tions ranging from zero to 6 points. The final score depressive mood, depressive thoughts and decreased ranges from zero to 60 points. An intraclass correla- energy. All the questions are of the yes/no type, and tion of 0.96 was observed for the agreement between the score is given by the number of questions that are different evaluators.
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