title: Midpoint of sleep on school days is associated with depression among adolescents.
abstract: Depression is a serious and prevalent disease among adolescents. Identifying possible factors involved with its genesis and presentation is an important task for researchers and clinical practitioners. The individual's chronotype and social jetlag have been associated with depression in different populations. However, information on this is lacking among adolescents. The objective of this cross-sectional study was to examine the relationship between chronotype (midpoint of sleep) and social jetlag with the presence of depression symptoms in young students. We assessed 351 students aged 12-21 years old. They answered a questionnaire on demographic characteristics, the Munich Chronotype Questionnaire (MCTQ) and the Beck Depression Inventory (BDI). Demographic characteristics (age, sex and classes' schedule) and circadian rhythmic variables for school and free days (sunlight exposure, sleep duration, midpoint of sleep and social jetlag) were taken as factors and the presence of at least mild depression symptoms as outcome. In univariate analysis, girls (χ(2) = 5.01, p ≤ 0.05) and evening students (χ(2) = 6.63, p ≤ 0.05) were more frequently present among the depressed. Also, the depression group was significantly delayed for both midpoints of sleep during school (t = 2.84, p ≤ 0.01) and free days (t = 2.20, p ≤ 0.05). The two groups did not differ in relation to their social jetlag hours (t = -0.68, p = 0.501) neither subjects with two or more hours of social jetlag were more frequent among the depressed (χ(2) = 1.00, p = 0.317). In multivariate analysis, the model that best explained our outcome (R(2) = 0.058, F = 2.318, p ≤ 0.05) included sex (β = -0.12, p ≤ 0.05) and the midpoint of sleep on school days (β = -0.21, p ≤ 0.001) as significant predictor variables. A sleep phase delay (later midpoints of sleep for school and free days) was associated with higher levels of depression. However, we were not able to detect similar relationship with the social jetlag hours. This could be attributed to the fact that our sample showed a smaller amount of social jetlag, possibly because even during free days a social routine, this time parents' rules, limited the observation from what could be a natural tendency to sleep later and over. Yet, even when considering the group with more social jetlag, we did not find an association. Perhaps, this variable will only manifest its effect if it is maintained for longer periods throughout life. Additionally, when considering all the variables together, the midpoint of sleep on school days was pointed as the predictor of greatest weight for depression, together with the factor sex. Young girls, possibly earlier types, who are required to study in the evening have more chances of presenting depression symptoms. This study explicit some peculiar characteristics of the assessment of chronobiological variables in the young, such as the presence of an imposed social routine also during free days. Therefore, the expression of chronotype under the influence of the weekly social schedule (midpoint of sleep on school days) could be a more useful marker to measure the stress produced from the mismatch between external and inner rhythms rather than social jetlag. This also reinforces the importance of reconsidering the weekly routine imposed on young people.
authors.affiliation: Laboratório de Cronobiologia, Hospital de Clínicas de Porto Alegre .
authors.forename: Camila Morelatto
authors.initials: CM
authors.lastname: de Souza
authors.forename: Maria Paz Loayza
authors.initials: MP
authors.lastname: Hidalgo
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000367:Age Factors; D016009:Chi-Square Distribution; D002648:Child; D002940:Circadian Rhythm; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D017440:Photoperiod; D012307:Risk Factors; D012737:Sex Factors; D012890:Sleep; D012919:Social Behavior; D013334:Students / Q000523:psychology*; D013472:Sunlight; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult